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Zhong R, Wang Z, Zhu Y, Wu X, Wang X, Wu H, Zhou J, Li X, Xu G, Pan M, Chen Z, Li W, Jiao Z, Li M, Zhang Y, Chen J, Chen X, Li N, Sun J, Zhang J, Hu S, Gan Z, Qin Y, Wang Y, Ma Y, Fang Y. Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China. J Affect Disord 2024; 367:333-341. [PMID: 39233245 DOI: 10.1016/j.jad.2024.08.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 08/24/2024] [Accepted: 08/31/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies. METHODS NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis. RESULTS The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were "cutting" (41.2 %) and "hitting" (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05). LIMITATIONS As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports. CONCLUSION Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.
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Affiliation(s)
- Rongrong Zhong
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, China
| | - Zuowei Wang
- Shanghai Hongkou Mental Health Center, 200083, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, 200083, China
| | - Yuncheng Zhu
- Shanghai Hongkou Mental Health Center, 200083, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, 200083, China.
| | - XiaoHui Wu
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, China
| | - Xiaoping Wang
- The Second Xiangya Hospital of Central South University, 410012, China
| | - Haishan Wu
- The Second Xiangya Hospital of Central South University, 410012, China
| | - Jia Zhou
- Beijing Anding Hospital, Capital Medical University, 100088, China
| | - Xiaohong Li
- Beijing Anding Hospital, Capital Medical University, 100088, China
| | - Guiyun Xu
- The Affiliated Brain Hospital of Guangzhou Medical University, 510370, China
| | - Miao Pan
- The Second Affiliated Hospital of Xinxiang Medical University, 453002, China
| | - Zhiyu Chen
- Hangzhou Seventh People's Hospital, 310063, China
| | - Wenfei Li
- Anhui Mental Health Center, 230022, China
| | - Zhian Jiao
- Shandong Provincial Hospital, 250021, China
| | - Mingli Li
- West China Hospital Sichuan University, 610044, China
| | | | | | - Xiuzhe Chen
- Shandong Mental Health Center, 250014, China
| | - Na Li
- The first Affiliated Hospital of Kunming Medical College, 650032, China
| | - Jing Sun
- Nanjing Brain Hospital, 210024, China
| | - Jian Zhang
- Shenzhen Kang Ning Hospital, 518020, China
| | - Shaohua Hu
- The First Affiliated Hospital Zhejiang University School of Medicine, 310003, China
| | - Zhaoyu Gan
- No. 3 Hospital of Zhongshan University, 510630, China
| | - Yan Qin
- Dalian Seventh People's Hospital, 116086, China
| | - Yumei Wang
- The First Hospital of Hebei Medical University, 50030, China
| | - Yantao Ma
- Peking University Institute of Mental Health, 100191, China
| | - Yiru Fang
- Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, China; Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025, China; Clinical Research Center for Mental Health, School of Medicine, Shanghai University, 200083, China.
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Cabrera-Mendoza B, Aydin N, Fries GR, Docherty AR, Walss-Bass C, Polimanti R. Estimating the direct effects of the genetic liabilities to bipolar disorder, schizophrenia, and behavioral traits on suicide attempt using a multivariable Mendelian randomization approach. Neuropsychopharmacology 2024; 49:1383-1391. [PMID: 38396255 PMCID: PMC11250798 DOI: 10.1038/s41386-024-01833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024]
Abstract
Bipolar disorder (BD) and schizophrenia (SZ) are associated with higher odds of suicide attempt (SA). In this study, we aimed to explore the effect of BD and SZ genetic liabilities on SA, also considering the contribution of behavioral traits, socioeconomic factors, and substance use disorders. Leveraging large-scale genome-wide association data from the Psychiatric Genomics Consortium (PGC) and the UK Biobank (UKB), we conducted a two-sample Mendelian randomization (MR) analysis to evaluate the putative causal effect of BD (41,917 cases, 371,549 controls) and SZ (53,386 cases, 77,258 controls) on SA (26,590 cases, 492,022 controls). Then, we assessed the putative causal effect of BD and SZ on behavioral traits, socioeconomic factors, and substance use disorders. Considering the associations identified, we evaluated the direct causal effect of behavioral traits, socioeconomic factors, and substance use disorders on SA using a multivariable MR approach. The genetic liabilities to BD and SZ were associated with higher odds of SA (BD odds ratio (OR) = 1.24, p = 3.88 × 10-12; SZ OR = 1.09, p = 2.44 × 10-20). However, while the effect of mental distress (OR = 1.17, p = 1.02 × 10-4) and risk-taking (OR = 1.52, p = 0.028) on SA was independent of SZ genetic liability, the BD-SA relationship appeared to account for the effect of these risk factors. Similarly, the association with loneliness on SA was null after accounting for the effect of SZ genetic liability. These findings highlight the complex interplay between genetic risk of psychiatric disorders and behavioral traits in the context of SA, suggesting the need for a comprehensive mental health assessment for high-risk individuals.
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Affiliation(s)
- Brenda Cabrera-Mendoza
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06516, USA.
- VA CT Healthcare System, West Haven, CT, 06516, USA.
| | - Necla Aydin
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06516, USA
- Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gabriel R Fries
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, Salt Lake City, UT, USA
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Consuelo Walss-Bass
- Translational Psychiatry Program, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, (UTHealth), 77054, Houston, TX, USA
- Neuroscience Graduate Program, The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, 77054, Houston, TX, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, 06516, USA
- VA CT Healthcare System, West Haven, CT, 06516, USA
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Pan Y, Wang H, Geng Y, Lai J, Hu S. Latent Profile Analysis of Suicidal Ideation in Chinese Individuals with Bipolar Disorder. Behav Sci (Basel) 2024; 14:360. [PMID: 38785851 PMCID: PMC11117804 DOI: 10.3390/bs14050360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/02/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Affiliation(s)
- Yanmeng Pan
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (Y.P.); (H.W.); (Y.G.)
| | - Huaizhi Wang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (Y.P.); (H.W.); (Y.G.)
- School of Psychiatry, Wenzhou Medical University, Wenzhou 325035, China
| | - Yimeng Geng
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (Y.P.); (H.W.); (Y.G.)
| | - Jianbo Lai
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (Y.P.); (H.W.); (Y.G.)
| | - Shaohua Hu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; (Y.P.); (H.W.); (Y.G.)
- Nanhu Brain-Computer Interface Institute, Hangzhou 310003, China
- Zhejiang Key Laboratory of Precision Psychiatry, Hangzhou 310003, China
- Brain Research Institute, Zhejiang University, Hangzhou 310003, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou 310003, China
- MOE Frontier Science Center for Brain Science and Brain-machine Integration, Zhejiang University, Hangzhou 310003, China
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou 310003, China
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Freitag S, Au JS, Liu DY, Mekawi Y, Lamis DA. Do bipolar disorder symptom profiles matter for suicide risk? A latent class approach to investigating differences in suicidal desire and acquired capability. Suicide Life Threat Behav 2024; 54:24-37. [PMID: 37937748 DOI: 10.1111/sltb.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Depressive and mixed symptoms in bipolar disorder (BD) have been linked to higher suicide risk. Based on Klonsky and May's three-step theory and Joiner's Interpersonal Psychological Theory of Suicide, we hypothesized that patients diagnosed with BD who reported severe levels of depressive symptoms and mixed depressive and manic symptoms would also report higher levels of suicidal desire and acquired capability of suicide, as well as suicidal thoughts and behaviors. METHODS The sample included 177 outpatients diagnosed with BD. Latent class analysis was conducted to replicate the identified groups of a previously conducted study using a smaller but overlapping dataset. Between-class and pairwise analyses with measures of suicidal desire and acquired capability were conducted. RESULTS As expected, the classes characterized by severe depressive symptoms and mixed symptoms reported higher levels of suicidal desire. However, the results regarding acquired capability were less consistent. CONCLUSION Given the overall elevated suicide risk of BD and the consistent relationship between depressive symptoms and other strong correlates of suicide, clinicians who work with patients diagnosed with BD should closely monitor changes in their depressive symptoms.
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Affiliation(s)
- Stephanie Freitag
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Josephine S Au
- Harvard T. H. Chan School of Public Health/Brigham and Women's Hospital/McLean Hospital, Boston, Massachusetts, USA
| | - Daphne Y Liu
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Bete T, Misgana T, Nigussie K, Aliye K, Abdeta T, Wedaje D, Hunduma G, Assefa A, Tesfaye D, Asfaw H, Amano A, Tariku M, Dereje J, Ali T, Mohammed F, Demissie M, Mohammed A, Hayru N, Assefa B, Wilfong T, Alemu D. Depressive disorder, bipolar disorder, and associated factors among adults, in the Eastern part of Ethiopia. BMC Psychiatry 2024; 24:17. [PMID: 38172755 PMCID: PMC10763018 DOI: 10.1186/s12888-023-05466-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Depressive disorder is one of the severe and common mental illnesses in the general population. Bipolar disorder is a severe, persistent mental illness associated with significant morbidity and mortality. However, there is a paucity of data on the prevalence of depressive disorder, and bipolar disorder in our study area. OBJECTIVE This study aimed to assess the prevalence of depressive and bipolar disorders among adults in Kersa, Haramaya, and Harar Health and Demographic Surveillance Sites in Eastern Ethiopia. METHODS A community-based cross-sectional study was conducted among 1,416 participants. A multi-stage sampling was employed to select the participants. DSM-5 diagnostic criteria was used to assess depressive disorder and bipolar disorder. Data was collected using a standard questionnaire. Data were entered into Epi-Data 3.1 and analyzed using SPSS version 26. Both binary and multivariate logistic regression analyses were done. Those with a p-value < 0.05 in the final model were considered statistically significant. RESULTS The overall prevalence of depressive and bipolar disorders among our study participants was 6.7% (95% CI: 5.40, 8.20) and 2.1% (95% CI: (1.40, 3.00), respectively. The independent predictors of depressive disorder included a family history of mental illness, chronic medical illnesses, unemployment, low educational status, divorced or widowed, poor social support, and current alcohol use or khat chewing. Single, males, divorced or widowed, and current consumers of alcohol were independent predictors for bipolar disorder. CONCLUSIONS AND RECOMMENDATION The results of our investigation showed that bipolar illness and depression were significant public health issues. It was shown that although bipolar disorder is highly prevalent in the society, depression is a widespread concern. As a result, it is imperative that the relevant body grow and enhance the provision of mental health services. Furthermore, research on the effects and burdens of bipolar disorder in the community is required.
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Affiliation(s)
- Tilahun Bete
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Tadesse Misgana
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Nigussie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kemal Aliye
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Abdeta
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawud Wedaje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gari Hunduma
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abduselam Assefa
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henock Asfaw
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Abdulkarim Amano
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mandaras Tariku
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Ali
- School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fethia Mohammed
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekdes Demissie
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Ahmed Mohammed
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nejiba Hayru
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Birhanu Assefa
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tara Wilfong
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Daniel Alemu
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Abbasi-Ghahramanloo A, Jafarzadeh M, Pourfarzi F, Afrashteh S, Azimi A, Yusuf MA, Adham D, Moradi-Asl E. Characteristics of suicide attempts in Northwestern Iran: a five-year population-based survey. BMC Psychiatry 2024; 24:15. [PMID: 38166930 PMCID: PMC10763457 DOI: 10.1186/s12888-023-05483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Suicide is a serious public health problem in the world. This study aims to describe the characteristics of suicide attempters in North-Western Iran and identify latent classes of suicide attempts. METHODS This cross-sectional study was conducted in Ardabil Province (Northwest Iran) during 2017-2021 based on a registration system for suicide attempts. We performed latent class analysis (LCA) using a procedure for LCA (PROC LCA) in SAS to investigate the subgroups of suicide attempters based on their characteristics and method, history, and outcome of suicide. RESULTS Three latent classes were identified for males and females; the first class (non-lethal attempters with lower educational levels) comprised 41.3% of males and 55.4% of females. The second class (non-lethal attempters with higher educational levels) described 52.4% of males and 42.7% of females. Finally, the third class (lethal attempters) included 6.4% of males and 1.9% of females. The main method of suicide attempts was poisoning with medications (87.3%). The results show that only 2.8% of people have a history of suicide attempts. Also, the suicide rate reached 8.26 per 100,000 population in 2021. CONCLUSION The present study showed an increasing trend of suicide attempt incidence rate in Ardabil Province from 2017 (99.49 per 100,000 population) to 2021 (247.41 per 100,000 population). This means that the rate of change was 147.92 per 100,000 population during the study period. The findings of LCA, stress the necessity of identification and prioritization of unmet needs of people who had an incomplete suicide in Ardabil.
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Affiliation(s)
- Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Jafarzadeh
- CDC of Ardabil Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Farhad Pourfarzi
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Sima Afrashteh
- Clinical Research Development Center, The Persian Gulf Martyrs Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ahad Azimi
- CDC of Ardabil Public Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mustpha Ahmed Yusuf
- Department of Medical Microbiology and Parasitology, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Davoud Adham
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Eslam Moradi-Asl
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran.
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Navarro D, Marín-Mayor M, Gasparyan A, García-Gutiérrez MS, Rubio G, Manzanares J. Molecular Changes Associated with Suicide. Int J Mol Sci 2023; 24:16726. [PMID: 38069051 PMCID: PMC10706600 DOI: 10.3390/ijms242316726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
Suicide is a serious global public health problem, with a worrying recent increase in suicide rates in both adolescent and adult populations. However, it is essential to recognize that suicide is preventable. A myriad of factors contributes to an individual's vulnerability to suicide. These factors include various potential causes, from psychiatric disorders to genetic and epigenetic alterations. These changes can induce dysfunctions in crucial systems such as the serotonergic, cannabinoid, and hypothalamic-pituitary-adrenal axes. In addition, early life experiences of abuse can profoundly impact an individual's ability to cope with stress, ultimately leading to changes in the inflammatory system, which is a significant risk factor for suicidal behavior. Thus, it is clear that suicidal behavior may result from a confluence of multiple factors. This review examines the primary risk factors associated with suicidal behavior, including psychiatric disorders, early life adversities, and epigenetic modifications. Our goal is to elucidate the molecular changes at the genetic, epigenetic, and molecular levels in the brains of individuals who have taken their own lives and in the plasma and peripheral mononuclear cells of suicide attempters and how these changes may serve as predisposing factors for suicidal tendencies.
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Affiliation(s)
- Daniela Navarro
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (D.N.); (A.G.); (M.S.G.-G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Marta Marín-Mayor
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
- Department of Psychiatry, Complutense University of Madrid, 28040 Madrid, Spain
| | - Ani Gasparyan
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (D.N.); (A.G.); (M.S.G.-G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (D.N.); (A.G.); (M.S.G.-G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Gabriel Rubio
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain;
- Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
- Department of Psychiatry, Complutense University of Madrid, 28040 Madrid, Spain
| | - Jorge Manzanares
- Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, Avda de Ramón y Cajal s/n, San Juan de Alicante, 03550 Alicante, Spain; (D.N.); (A.G.); (M.S.G.-G.)
- Redes de Investigación Cooperativa Orientada a Resultados en Salud (RICORS), Red de Investigación en Atención Primaria de Adicciones (RIAPAd), Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain;
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
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Khoso AB, Noureen A, Un Nisa Z, Hodkinson A, Elahi A, Arshad U, Naz A, Bhatti MM, Asif M, Husain MO, Husain MI, Chaudhry N, Husain N, Chaudhry IB, Panagioti M. Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis. BJPsych Open 2023; 9:e179. [PMID: 37814419 PMCID: PMC10594255 DOI: 10.1192/bjo.2023.570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/11/2023] Open
Abstract
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.
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Affiliation(s)
- Ameer B. Khoso
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Amna Noureen
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Zaib Un Nisa
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Alexander Hodkinson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Anam Elahi
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, UK
| | - Usman Arshad
- Division of Child and Adolescent Mental Health, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Anum Naz
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | | | - Muqaddas Asif
- Division of Substance-Related and Addiction Disorders, Pakistan Institute of Living and Learning, Lahore, Pakistan; and Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Muhammad Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Muhammad Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Nasim Chaudhry
- Division of Neurodevelopmental Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Mersey Care NHS Foundation Trust, Prescot, UK
| | - Imran B. Chaudhry
- Division of At-Risk Mental State, Schizophrenia Spectrum, and other Psychotic Disorders, Pakistan Institute of Living and Learning, Karachi, Pakistan; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; and Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| | - Maria Panagioti
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK; and National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
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9
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Stubbe DE. Engaging Through the Elation: Forming an Early Therapeutic Rapport With a Patient With Bipolar Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:389-393. [PMID: 38695009 PMCID: PMC11058950 DOI: 10.1176/appi.focus.20230017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Affiliation(s)
- Dorothy E Stubbe
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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10
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Goldstein TR, Merranko J, Hafeman D, Gill MK, Liao F, Sewall C, Hower H, Weinstock L, Yen S, Goldstein B, Keller M, Strober M, Ryan N, Birmaher B. A Risk Calculator to Predict Suicide Attempts Among Individuals With Early-Onset Bipolar Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:412-419. [PMID: 38695011 PMCID: PMC11058951 DOI: 10.1176/appi.focus.23021023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Objectives To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder. Methods Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC. Results There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history. Conclusions This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.Reprinted from Bipolar Disord 2022; 24:749-757, with permission from John Wiley and Sons. Copyright © 2022.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Craig Sewall
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Heather Hower
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Lauren Weinstock
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Shirley Yen
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Benjamin Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Martin Keller
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Michael Strober
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (Goldstein, Merranko, Hafeman, Gill, Liao, Sewall, Ryan, Birmaher); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA (Hower, Weinstock, Yen, Keller); Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA (Yen); Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada (Goldstein); Department of Psychiatry, University of California, Los Angeles, California, USA (Strober)
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11
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Izadi N, Mitchell RHB, Giacobbe P, Nestor S, Steinberg R, Amini J, Sinyor M, Schaffer A. Suicide Assessment and Prevention in Bipolar Disorder: How Current Evidence Can Inform Clinical Practice. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:380-388. [PMID: 38695007 PMCID: PMC11058945 DOI: 10.1176/appi.focus.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
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.
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Affiliation(s)
- Niloofar Izadi
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Sean Nestor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Rosalie Steinberg
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Jasmine Amini
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
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12
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Ehret BC, Titone MK, Carey CJ, Martinez A, Chalker SA, Granholm EL, Depp CA. Are all reasons for living made equally? Reasons for living and dysfunctional attitudes in psychotic disorders and bipolar I. Psychol Psychother 2023; 96:748-761. [PMID: 37039342 DOI: 10.1111/papt.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Persons with schizophrenia, schizoaffective, or bipolar I disorder are more likely to die by suicide compared to the general population. Dysfunctional attitudes have been shown to be significant predictors of cognitive vulnerability to depression, hopelessness, and poor problem-solving skills, which predict suicidal ideation. Dysfunctional attitudes are common in persons with schizophrenia spectrum disorders (SSDs) and bipolar I. The Reasons for Living Inventory (RFLI) examines distinct reasons for not dying by suicide. This study's objectives were to examine the relationship between the RFLI subscales and dysfunctional attitudes among persons with SSDs and bipolar I. We hypothesized significant positive correlations between two RFLI subscales (Fear of Suicide and Fear of Social Disapproval) and total score on the Dysfunctional Attitude Scale (DAS). We did not expect significant correlations between other subscales. DESIGN AND METHODS This correlational, cross-sectional study examined baseline scores on the RFLI and dysfunctional attitudes (DAS) among N = 102 outpatients with SSDs or bipolar I. RESULTS Significant positive correlations were observed between RFLI subscales Fear of Suicide and Fear of Social Disapproval and DAS total scores. No other significant relationships were observed. CONCLUSIONS Certain reasons for living (i.e. fear of suicide and social disapproval) may be associated with dysfunctional attitudes among persons with SSDs or bipolar I. These, in turn, may place these individuals at a greater risk for suicide by increasing their cognitive vulnerability. These findings may inform clinical treatment targets for persons with SSDs and bipolar I.
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Affiliation(s)
- Blaire C Ehret
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Madison K Titone
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin J Carey
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Alexandra Martinez
- Graduate School of Education and Psychology, Pepperdine University, Malibu, California, USA
| | - Samantha A Chalker
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Eric L Granholm
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Colin A Depp
- Department of Veterans Affairs, Virginia San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, California, USA
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13
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He QY, Dai N, Mao M, Ma J, Wen Q, Song DD, Liu Y, Li F. Insomnia and circadian rhythm: a bibliometrics study and visualization analysis via CiteSpace. Front Neurol 2023; 14:1184302. [PMID: 37396774 PMCID: PMC10308182 DOI: 10.3389/fneur.2023.1184302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The present study aimed to use CiteSpace to analyze the status of insomnia and circadian rhythm, identify the hot spots and trends, and provide a basis for future study. Method The Web of Science database was searched for studies related to insomnia and circadian from its inception to 14 April 2023. CiteSpace was used to generate online maps of collaboration between countries and authors and revealed hot spots and frontiers in insomnia and circadian rhythm. Results We searched 4,696 publications related to insomnia and circadian rhythm. Bruno Etain was the most prolific author with most publications, i.e., with 24 articles. The USA and the University of California were the leading country and the top institution in this field of study, with 1,672 and 269 articles, respectively. There was active cooperation between institutions, countries, and authors. Hot topics focused on circadian rhythm sleep disorders, circadian clock, light therapy, melatonin, and bipolar disorder. Conclusion Based on the CiteSpace results, we recommend a more active collaboration between various countries, institutions, and authors to conduct clinical and basic research related to insomnia and circadian rhythm. Ongoing research focuses on the interaction of insomnia with circadian rhythms and the corresponding pathways of clock genes and by extension, the role of circadian rhythms in disorders such as bipolar disorder. Modulation of circadian rhythms may be a hot spot for future insomnia therapies (such as light therapy and melatonin).
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Affiliation(s)
- Qing-Yun He
- Department of Diagnosis of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Ning Dai
- Research Institutes, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Meng Mao
- Department of Ethnic Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jie Ma
- Department of Diagnosis of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Qiao Wen
- Department of Brain Diseases, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Dan-Dan Song
- Department of Diagnosis of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Liu
- Scientific Research Center, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Feng Li
- Department of Diagnosis of Traditional Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Rohde C, Köhler-Forsberg O, Nierenberg AA, Østergaard SD. Pharmacological treatment of bipolar disorder and risk of diabetes mellitus: A nationwide study of 30,451 patients. Bipolar Disord 2023; 25:323-334. [PMID: 36751986 DOI: 10.1111/bdi.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE While treatment with antipsychotics and antiepileptics have been associated with an increased risk of diabetes mellitus (DM), lithium may have the opposite effect via inhibition of glycogen synthase kinase-3. The aim of this study was to investigate whether treatment of bipolar disorder with lithium, antipsychotics, or antiepileptics is associated with the risk of DM in a real-world clinical setting. METHODS Using nationwide registers, we identified all patients diagnosed with bipolar disorder in Danish Psychiatric Services from January 1, 1996, to January 1, 2019 (N = 30,451). The risk of developing DM was operationalized via hospital diagnoses and redeemed prescriptions for glucose-lowering drugs. For lithium, antipsychotics, valproate, and lamotrigine, we calculated hazard rate ratios (HRR) for developing DM via adjusted Cox proportional hazards models. Potential cumulative dose-response-like associations were examined using the log-rank test. RESULTS During follow-up (245,181 person-years), 2107 (6.9%) patients developed DM. Compared with non-users of the respective drugs, we found no clinically or statistically significant difference in the risk of developing DM among patients receiving lithium (n = 11,690; incidence rate of DM/1000 person-years (IR) = 8.87, 95% CI: 8.02-9.90; HRR = 0.94, 95% CI: 0.84-1.06) or lamotrigine (n = 11,785; IR = 7.58, 95% CI: 6.69-8.59; HRR = 0.89, 95% CI: 0.77-1.02), respectively. Conversely, for patients receiving valproate (n = 5171; IR = 12.68, 95% CI: 10.87-14.80; HRR = 1.34, 95% CI: 1.14-1.58) and antipsychotics (n = 22,719; IR = 12.00, 95% CI: 11.14-12.94; HRR = 1.65, 95% CI: 1.45-1.88), respectively, there was increased risk of developing DM. For antipsychotics, we observed a clear cumulative dose-response-like association with the risk of DM. CONCLUSIONS Treatment with valproate and antipsychotics-but not with lithium and lamotrigine-was associated with increased risk of DM in a real-world cohort of patients with bipolar disorder.
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Affiliation(s)
- Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Andrew A Nierenberg
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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García-Jiménez J, Gómez-Sierra FJ, Martínez-Hortelano A, Moreno-Merino P, Girela-Serrano B, Molero P, Gutiérrez-Rojas L. Cigarette smoking and risk of suicide in bipolar disorder: a systematic review. Front Psychiatry 2023; 14:1179733. [PMID: 37275988 PMCID: PMC10235444 DOI: 10.3389/fpsyt.2023.1179733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023] Open
Abstract
Objective Bipolar disorder (BD) is a highly prevalent, chronic and recurrent mental illness. The smoking rates in patients with BD are much higher than those of the general population, and BD is associated with an increased risk of suicide. An association between smoking and suicidal behavior has been found in the general population, this systematic review examines whether there is evidence of an association between smoking and suicide behavior in patients with BD. Method A database search was carried out in Medline, Embase, The Cochrane Library, Scopus, and Web of Science, updated until December 31st, 2021, according to the 2020 PRISMA guidelines. We identified prospective and retrospective studies that included patients diagnosed with BD types I, II, and not otherwise specified, and in which smoking and suicidal behavior were correlated. Articles that focused exclusively on other mental disorders were excluded. The Ottawa-Newcastle scale was used to assess the methodological quality of the included articles. Results Fifteen articles (n = 7,395) met all the inclusion criteria. In nine of these articles, the authors found an association between smoking and suicidal behavior in BD, while in the remaining six articles, this association was not found. A great deal of variability was observed between articles, particularly in the measurement of suicidal behavior and tobacco consumption. The risk of bias, as assessed by the NOS, was high for most of the included articles, except for two papers, whose risk was low. Conclusion It was not possible to establish a clear relationship between tobacco use and the risk of suicide in BD patients due to the heterogeneity of the articles included in this systematic review, which had different sample sizes and methodological issues. However, both conditions are highly prevalent and have a negative impact on the prognosis of BD. Therefore, a systematic approach is needed, based on accurate measurement of a patient's smoking habits and their risk of suicidal behavior, in order to establish an appropriate therapeutic plan. Additional information This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors and was registered on PROSPERO with the CRD42022301570 on January 21th 2022.
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Affiliation(s)
| | | | | | - Paula Moreno-Merino
- Mental Health Unit at Estepona, Virgen de la Victoria Hospital, Málaga, Spain
| | - Braulio Girela-Serrano
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Patricio Molero
- Department of Psychiatry and Medical Psychology, University Clinic of Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, San Cecilio University Hospital, Granada, Spain
- Psychiatry and Neuroscience Research Group (CTS-549), Neuroscience Institute, University of Granada, Granada, Spain
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16
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Abaatyo J, Favina A, Bulega SE, Kaggwa MM. Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda. BMC Psychiatry 2023; 23:346. [PMID: 37208631 PMCID: PMC10196297 DOI: 10.1186/s12888-023-04858-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda. METHOD This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals. RESULTS The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036). CONCLUSION Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.
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Affiliation(s)
- Joan Abaatyo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alain Favina
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Steven Elijah Bulega
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, McMaster, Canada.
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17
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Peters M, Boersma HW, van Rossum PS, van Oort J, Cahn W, Verhoeff JJ. The impact of schizophrenia spectrum disorder, bipolar disorder and borderline personality disorder on radiotherapy treatment and overall survival in cancer patients: A matched pair analysis. Clin Transl Radiat Oncol 2023; 40:100618. [PMID: 37066114 PMCID: PMC10090213 DOI: 10.1016/j.ctro.2023.100618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
Introduction The effect of a psychiatric disorder (PD) on the choice of radiotherapy regimens and subsequent cancer control outcomes is largely unknown. In this study, we evaluated differences in radiotherapy regimens and overall survival (OS) between cancer patients with a PD in comparison with a control population of patients without a PD. Methods Referred patients with a PD (i.e. schizophrenia spectrum disorder, bipolar disorder or borderline personality disorder) were included through a text-based search of the electronic patient database of all the patients that received radiotherapy between 2015 and 2019 at a single centre. Each patient was matched to a patient without a PD. Matching was based on cancer type, staging, performance score (WHO/KPS), non-radiotherapeutic cancer treatment, gender and age. Outcomes were the amount of fractions received, total dose, and OS. Results 88 patients with PD were identified; 44 patients with schizophrenia spectrum disorder, 34 with bipolar disorder, and 10 with borderline personality disorder. Matched patients without a PD showed similar baseline characteristics. No statistically significant difference was observed regarding the number of fractions with a median of 16 (interquartile range [IQR] 3-23) versus 16 (IQR 3-25), respectively (p = 0.47). Additionally, no difference in total dose was found. Kaplan-Meier curves showed a statistically significant difference in OS between the patients with a PD versus those without a PD, with 3-year OS rates of 47 % versus 61 %, respectively (hazard ratio 1.57, 95 % confidence interval 1.05-2.35, p = 0.03). No clear differences in causes of death were observed. Conclusion Cancer patients referred for radiotherapy with schizophrenia spectrum disorder, bipolar disorder or borderline personality disorder receive similar radiotherapy schedules for a variety of tumour types but attain worse survival.
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18
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Identification of Risk Factors for Suicide and Insights for Developing Suicide Prevention Technologies: A Systematic Review and Meta-Analysis. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2023. [DOI: 10.1155/2023/3923097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Suicide is a termite that engulfs close to seven hundred thousand people worldwide each year. Existing work on risk factors that predict suicide lacks statistical associations, does not consider most countries, and has a wide range of risk factor domains. The goal of this systematic review and meta-analysis is to enhance our current understanding of suicidality by identifying risk factors that are most strongly associated with suicide and their impact on developing technological interventions for suicide prevention. A search strategy was carried out on four databases: (1) PsycINFO, (2) IEEE Xplore, (3) the ACM Digital Library, and (4) PubMed, and twenty-five studies were included based on the inclusion criteria. Factors statistically associated with suicide are any diagnosed mental disorder, adverse life events, past suicide attempts, low education level, loneliness or high levels of isolation, bipolar disorder, depression, multiple chronic health conditions, family history of suicide, sexual trauma, and being female. Domain-wise, comorbid disorders, and behavior-related risk factors are most strongly associated with suicide. We present a new hierarchical model of risk factors for suicide that advances our understanding of suicide and its causes. Finally, we present open research directions and considerations for developing suicide prevention technologies.
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Naggan L, Robinson E, Dinur E, Goldenberg H, Kozela E, Yirmiya R. Suicide in bipolar disorder patients is associated with hippocampal microglia activation and reduction of lymphocytes-activation gene 3 (LAG3) microglial checkpoint expression. Brain Behav Immun 2023; 110:185-194. [PMID: 36863492 DOI: 10.1016/j.bbi.2023.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/20/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is associated with marked functional impairments along with increased rate of suicide. Although there is ample evidence for the involvement of inflammatory processes and microglia activation in the pathophysiology of BD, the mechanisms that regulate these cells in BD patients, and particularly the role of microglia checkpoints, is still unclear. METHODS Immunohistochemical analyses of hippocampal sections from post-mortem brains of 15 BD patients and 12 control subjects were used to assess microglia density, by staining the microglia-specific receptor P2RY12, and microglia activation, by staining the activation marker MHC II. Given recent findings on the involvement of LAG3, which interacts with MHC II and serves as a negative microglia checkpoint, in depression and electroconvulsive therapy, we assessed the levels of LAG3 expression and their correlations with microglia density and activation. RESULTS There were no overall differences between BD patients and controls, but BD patients who committed suicide (N = 9) displayed a significant elevation in the overall microglia density and the density of MHC II-labeled microglia (but not other MHC II-labeled cells), compared with no suicide BD patients (N = 6) and controls. Furthermore, the percent of microglia expressing LAG3 was significantly reduced only in suicidal BD patients, with significant negative correlations between microglial LAG3 expression levels and the density of microglia, in general, and activated microglia, in particular. CONCLUSION Suicidal BD patients exhibit microglia activation, which is possibly mediated by reduced LAG3 checkpoint expression, suggesting that anti-microglial therapeutics, including LAG3 modulators, may be beneficial for this subgroup of patients.
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Affiliation(s)
- Lior Naggan
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Robinson
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Dinur
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagar Goldenberg
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ewa Kozela
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raz Yirmiya
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
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20
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Villa LM, Colic L, Kim JA, Sankar A, Goldman DA, Lessing B, Pittman B, Alexopoulos GS, van Dyck CH, Blumberg HP. Aging of the brain in bipolar disorder: Illness- and onset-related effects in cortical thickness and subcortical gray matter volume. J Affect Disord 2023; 323:875-883. [PMID: 36526112 PMCID: PMC9839524 DOI: 10.1016/j.jad.2022.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older adults with bipolar disorder (BD) have received little study, although they often have severe symptoms, treatment resistance and high suicide risk. Furthermore, a subset develops cognitive dysfunction for unknown reasons. METHODS Here, cortical thickness and subcortical gray matter volume were compared across individuals ages 40-79y: 103 with BD ("later-onset" at ages ≥25y, n = 21; "early-onset" < 25y, n = 82) and healthy controls (HCs, n = 98). RESULTS Overall, those with BD showed lower prefrontal, cingulate, sensorimotor, parahippocampal, insula, temporal, parietal, and occipital cortical thickness (Cohen's d: 0.4 to 0.8) and hippocampal, amygdalar, thalamic, and striatal gray matter volume (d: 0.6 to 0.8). Later-onset BD showed negative relationships between age and parahippocampal, insular, temporal, parietal, and occipital cortical thickness, and hippocampal, thalamic and striatal volume (r: -0.7 to -0.4). Suicide attempt history was associated with lower dorsolateral prefrontal cortical thickness (d = 0.5). LIMITATIONS The study used a cross-sectional design and the sample of those with a later-onset of BD was relatively modest. CONCLUSIONS Results support widespread gray matter decreases in older adults with BD, and also suggest a separable later-onset phenotype characterized by age-related gray matter reductions in regions subserving cognitive, emotional and perceptual processes. Moreover, the results are the first to demonstrate structural brain differences associated with a history of suicide attempts in older adults with BD.
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Affiliation(s)
- Luca M Villa
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lejla Colic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany; German Center for Mental Health, Halle-Jena-Magdeburg, Germany
| | - Jihoon A Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Anjali Sankar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Danielle A Goldman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brandon Lessing
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Christopher H van Dyck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA; Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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21
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Goldstein TR, Merranko J, Hafeman D, Gill MK, Liao F, Sewall C, Hower H, Weinstock L, Yen S, Goldstein B, Keller M, Strober M, Ryan N, Birmaher B. A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder. Bipolar Disord 2022; 24:749-757. [PMID: 36002150 DOI: 10.1111/bdi.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder. METHODS Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC. RESULTS There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history. CONCLUSIONS This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Craig Sewall
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Martin Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Strober
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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22
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Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry 2022; 12:303. [PMID: 35906234 PMCID: PMC9335454 DOI: 10.1038/s41398-022-02045-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has a disproportionate impact on vulnerable subpopulations, including those with severe mental illness (SMI). This study examined the one-year prevalence of suicidal ideation (SI), suicide plans (SP), and suicide attempts (SA) in bipolar disorder (BD) and schizophrenia (SCZ) patients during the pandemic. Prevalence rates were compared between the two disorders and associated factors were examined. A survey was conducted in six tertiary psychiatric hospitals and psychiatric units. People with a diagnosis of BD or SCZ were invited to participate. SI, SP, and SA (suicidality for short) were assessed and associated factors were examined using binary logistical regression. The 1-year prevalence of SI, SP and SA in BD patients were 58.3%, (95% CI: 54.1-62.6%), 38.4% (95% CI: 34.3-42.6%) and 38.6% (95% CI: 34.5-42.8%), respectively, which were higher than the corresponding figures in SCZ patients (SI: 33.2%, 95% CI: 28.6-37.8%; SP: 16.8%, 95% CI: 13.2-20.5%; SA: 19.4%, 95% CI: 15.5-23.3%). Patients with younger age, experience of cyberbullying, a history of SA among family or friends, a higher fatigue and physical pain score, inpatient status, and severe depressive symptoms were more likely to have suicidality. The COVID-19 pandemic was associated with increased risk of suicidality, particularly in BD patients. It is of importance to regularly screen suicidality in BD and SCZ patients during the pandemic even if they are clinically stable.
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23
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Lage RR, de Assis da Silva R, Tancini MB, Nardi AE, Mograbi DC, Cheniaux E. Suicidal Ideation in Bipolar Disorder: The Relation with Clinical and Sociodemographic Variables. Psychiatr Q 2022; 93:453-461. [PMID: 34664176 DOI: 10.1007/s11126-021-09965-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 07/31/2021] [Accepted: 09/30/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Bipolar disorder (BD) has the highest risk of suicide among all mental disorders. Thus, identifying factors related to suicidal ideation is essential for a better assessment of the risk of suicide in BD. OBJECTIVE To analyze the relationship between suicidal ideation and clinical and sociodemographic characteristics in BD patients. METHOD This is a cross-sectional study that included eighty individuals with BD. Information regarding sociodemographic data and history of attempted suicide were collected, and the Hamilton Depression Scale, Young Mania Rating Scale, Positive And Negative Syndrome Scale/positive symptom subscale, Clinical Global Impressions Scale for use in bipolar illness, Insight Scale for Affective Disorders, and Barratt Impulsiveness Scale were administered. The presence and severity of suicidal ideation were assessed using the Beck Scale for Suicidal Ideation. RESULTS All regression models significantly predicted suicidal ideation. In the model that had the lowest AIC score and the highest cross-validity, the severity of depressive and of manic symptoms (standardized β = 0.49, p < 0.001; standardized β = 0.42, p = 0.007), the insight level (standardized β = - 0.38, p = 0.012) and previous suicide attempt (standardized β = 0.20, p = 0.036) acted as predictors of suicidal ideation, while degree of impulsivity (β standardized = 0.13, p = 0.229) and educational level (standardized β = - 0.16, p = 0.108) did not give a significant contribution. CONCLUSION According to our results, more severe depression and mania symptoms, higher level of insight and a history of suicide attempt indicate the occurrence of suicidal ideation in BD.
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Affiliation(s)
- Renata Reis Lage
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil.
| | - Rafael de Assis da Silva
- Department of Psychology, Pontifícia Universidade Católica-Rio, Rio de Janeiro, Brazil.,School of Medicine and Surgery, Federal University of the State of Rio de Janeiro (Unirio), Rio de Janeiro, Brazil
| | - Marcelo Baggi Tancini
- Department of Psychology, Pontifícia Universidade Católica-Rio, Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil
| | - Daniel C Mograbi
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil.,Department of Psychology, Pontifícia Universidade Católica-Rio, Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Elie Cheniaux
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Av. Venceslau Brás, 71, fundos, CEP 22290-140, Rio de Janeiro, RJ, Brazil.,Medical Sciences College, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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24
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McGrath T, Baskerville R, Rogero M, Castell L. Emerging Evidence for the Widespread Role of Glutamatergic Dysfunction in Neuropsychiatric Diseases. Nutrients 2022; 14:nu14050917. [PMID: 35267893 PMCID: PMC8912368 DOI: 10.3390/nu14050917] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
The monoamine model of depression has long formed the basis of drug development but fails to explain treatment resistance or associations with stress or inflammation. Recent animal research, clinical trials of ketamine (a glutamate receptor antagonist), neuroimaging research, and microbiome studies provide increasing evidence of glutamatergic dysfunction in depression and other disorders. Glutamatergic involvement across diverse neuropathologies including psychoses, neurodevelopmental, neurodegenerative conditions, and brain injury forms the rationale for this review. Glutamate is the brain's principal excitatory neurotransmitter (NT), a metabolic and synthesis substrate, and an immune mediator. These overlapping roles and multiple glutamate NT receptor types complicate research into glutamate neurotransmission. The glutamate microcircuit comprises excitatory glutamatergic neurons, astrocytes controlling synaptic space levels, through glutamate reuptake, and inhibitory GABA interneurons. Astroglia generate and respond to inflammatory mediators. Glutamatergic microcircuits also act at the brain/body interface via the microbiome, kynurenine pathway, and hypothalamus-pituitary-adrenal axis. Disruption of excitatory/inhibitory homeostasis causing neuro-excitotoxicity, with neuronal impairment, causes depression and cognition symptoms via limbic and prefrontal regions, respectively. Persistent dysfunction reduces neuronal plasticity and growth causing neuronal death and tissue atrophy in neurodegenerative diseases. A conceptual overview of brain glutamatergic activity and peripheral interfacing is presented, including the common mechanisms that diverse diseases share when glutamate homeostasis is disrupted.
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Affiliation(s)
- Thomas McGrath
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (T.M.); (L.C.)
| | - Richard Baskerville
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0BP, UK
- Correspondence:
| | - Marcelo Rogero
- School of Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil;
| | - Linda Castell
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (T.M.); (L.C.)
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25
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Guo Y, Xu ZYR, Cai MT, Gong WX, Shen CH. Epilepsy With Suicide: A Bibliometrics Study and Visualization Analysis via CiteSpace. Front Neurol 2022; 12:823474. [PMID: 35111131 PMCID: PMC8802777 DOI: 10.3389/fneur.2021.823474] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/22/2021] [Indexed: 01/09/2023] Open
Abstract
Objective:The purpose of this study was to analyze the research status of epilepsy with suicide and to determine the hotspots and frontiers via CiteSpace.Method:We searched the Web of Science Core Collection (WoSCC) for studies related to epilepsy and suicide from inception to September 30, 2021. We used CiteSpace to generate online maps of collaboration between countries, institutions, and authors, and revealed hot spots and frontiers in epilepsy with suicide.Results:A total of 631 publications related to epilepsy with suicide were retrieved from the WoSCC. Andres M. Kanner was the most published author (25 papers). The USA and Columbia University were the leading country and institution in this field, with 275 and 25 papers, respectively. There were active cooperation between institutions, countries, and authors. Hot topics focused on depression, antiseizure medications, pediatric epilepsy, and risk factors of suicide in patients with epilepsy (PWEs).Conclusions:Based on the CiteSpace findings, this study detected active collaboration among countries, institutions and authors. The main current research trends include suicide caused by depression, suicide caused by the use of antiseizure medications, suicide in children with epilepsy, and risk factors for suicide in PWEs. Thus, more attention should be paid to the psychiatric comorbidity of PWEs (especially pediatric epilepsy), the suicidal tendency of PWEs, and the rational use of antiseizure medications in the future.
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Affiliation(s)
- Yi Guo
- Department of General Practice and International Medicine, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Yi Guo
| | - Zheng-Yan-Ran Xu
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Xin Gong
- Department of General Practice and International Medicine, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Epilepsy Center, School of Medicine, Zhejiang University, Hangzhou, China
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Yan X, Xu P, Sun X. Circadian rhythm disruptions: A possible link of bipolar disorder and endocrine comorbidities. Front Psychiatry 2022; 13:1065754. [PMID: 36683994 PMCID: PMC9849950 DOI: 10.3389/fpsyt.2022.1065754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
Epidemiological studies have demonstrated an association between bipolar disorder (BP) and endocrine diseases. Further, circadian rhythm disruptions may be a potential common pathophysiological mechanism of both disorders. This review provides a brief overview of the molecular mechanisms of circadian rhythms, as well as roles circadian rhythms play in BP and common endocrine comorbidities such as diabetes and thyroid disease. Treatments targeting the circadian system, both pharmacological and non-pharmacological, are also discussed. The hope is to elicit new interest to the importance of circadian system in BP and offer new entry points and impetus to the development of medicine.
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Affiliation(s)
- Xiu Yan
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Peiwei Xu
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Xueli Sun
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
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Yeh TC, Bai YM, Hsu JW, Huang KL, Tsai SJ, Chu HT, Liang CS, Chen MH. Bipolar women's antepartum psychotropic exposure and offspring risk of attention-deficit/hyperactivity disorder and autism spectrum disorder. J Affect Disord 2021; 295:1407-1414. [PMID: 34565590 DOI: 10.1016/j.jad.2021.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/23/2021] [Accepted: 09/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Women with bipolar disorder (BD) may continue psychotropics during pregnancy. The association of exposure to antidepressant, antipsychotics, and mood stabilizers with offspring risks of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) remains unexplored in mothers with BD. METHODS A total of 5669 pregnant women with BD and 5669 psychiatrically healthy controls were identified between 2002 and 2011 from the Taiwan Longitudinal Health Insurance Database. We analyzed the odds ratios (ORs) of psychotropic types and exposure periods (3 months before pregnancy [3MbPreg] and first, second, and third trimesters [T1, T2, T3, respectively]) on the risk of ADHD and ASD by using adjusted logistic regression analyses. RESULTS Antidepressant exposure during 3MbPreg (OR=2.15, 95% CI=1.45-3.20), T1 (OR=2.62, 95% CI=1.68-4.09), T2 (OR=2.33, 95% CI=1.18-4.63), and T3 (OR=2.33, 95% CI=1.67-6.61) was associated with increased offspring risk of ADHD, particularly for selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor. Mood stabilizer exposure during 3MbPreg increased the risks of ADHD (OR=2.39, 95% CI=1.45-3.95) and ASD (OR=3.89, 95% CI=1.30-11.65); a higher ADHD risk was associated with valproic acid (OR=2.43, 95% CI=1.32-4.47) and lamotrigine exposure (OR=8.24, 95% CI = 1.49-45.67); ASD risk was higher for lithium exposure (OR=6.75, 95% CI=1.41-32.28). LIMITATION In claims-data analyses, several clinical parameters or potential confounders may be incompletely captured. CONCLUSIONS Antidepressants were associated with higher offspring risk of ADHD over all gestation periods among mothers with BD than psychiatrically healthy controls, while mood stabilizers were associated with higher risk of ADHD and ASD during 3MbPreg.
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Affiliation(s)
- Ta-Chuan Yeh
- Department of Psychiatry, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Penghu Branch, Tri-Service General Hospital, Penghu, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ju-Wei Hsu
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Ling Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Te Chu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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de Araújo RMF, Zanotto M, da Rosa LR, Mazzochi L, Lara DR. Sensitivity is the dimension of temperament most associated with the progression from ideation to suicide attempts. J Affect Disord 2021; 294:695-700. [PMID: 34343927 DOI: 10.1016/j.jad.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND To analyze the association between temperament (emotional and affective) and scrutinize the progression from suicide ideation to attempt, by using data from a large internet-based sample. METHODS It is a cross-sectional study, based on the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Temperament was assessed by the Affective and Emotional Composite Temperament Scale (AFECTS), and life-long suicidal behavior was determined by the adapted Suicidal Behaviors Questionnaire (SBQ-17). Odds ratios were obtained through multivariate logistic regression and a multiple linear regression were used in the analysis. According to the "ideation-to-action framework", we performed analyzes using two different reference groups: no suicidal ideation and suicidal ideation. RESULTS The affective temperaments that showed the greatest association with suicide attempts were depressive, cyclothymic, and volatile. The temperaments that reflected higher associations for progression from ideation to suicide attempt were cyclothymic, depressive, and euphoric. Sensitivity was manifested as the emotional temperament with the strongest positive association with the severity of suicidal behavior, followed by desire and control. Stability was estimated as the emotional trait with the strongest negative association with the severity of suicidal behavior. LIMITATIONS It is not a population based sample. BRAINSTEP is a self-selected sample whose participants are mostly women, who are highly educated and young. CONCLUSIONS Our results suggest that temperament assessment using AFECT model may be relevant to assess the risk for the progression from ideation to suicide attempts. These results strengthen the "ideation-to-action" framework that risk factors to suicide ideators can differ from suicide attempters.
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Affiliation(s)
- Rafael M F de Araújo
- Universidade do Vale do Taquari, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | | | | | - Leonardo Mazzochi
- Universidade do Vale do Taquari, Lajeado, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Diogo R Lara
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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[Suicidal behaviors in bipolar disorder type 1]. Encephale 2021; 48:632-637. [PMID: 34654568 DOI: 10.1016/j.encep.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Bipolar disorder is one of the most common and severe psychiatric conditions. It is frequently complicated by suicidal behaviors, and patients with BD are among those at higher risk of suicide. The aims of our study were to evaluate the predictive factors of suicidal behaviors in patients with BD type 1, through the assessment of their socio-demographic, clinical and evolutionary characteristics as well as to study the implications of the childhood traumas and impulsivity as predictive factors for suicidal behaviors in these patients with bipolar disorder. METHODS One hundred patients with bipolar disorder type 1were recruited in order to conduct a cross-sectional, analytical and comparative study. The recruitment involved a first group made up of 40 patients suffering from type 1 bipolar disorder with a history of suicidal acts. This group was compared with a second group made up of 60 patients with no history of attempted suicide. We used a pre-established collection sheet for collecting socio-demographic, clinical and therapeutic data. We also used the Childhood Trauma Questionnaire for the assessment of childhood adversities, the Barratt Impulsivity Scale in its eleventh version for the assessment of impulsivity levels and the Global Assessment of Functioning Scale for the evaluation of overall functioning. RESULTS The suicidal behaviors in patients with bipolar disorder were significantly associated with: female gender (P<0.001), professional instability (P=0.002), family history of BD (P=0.02), family history of other psychiatric disorders (P=0.003), frequency of depressive episodes (P=0.002), shorter remission (P=0.025), more subsyndromal symptoms (P=0.029), sexual abuse dimension (P=0.009), and a high level of impulsivity (P<0.001). The predictive factors for suicidal behaviors in multivariate analysis, after adjusting for the confounding variables were: childhood sexual abuse (P=0.01; adjusted OR 4.5; 95% CI 1.44-14.2), a high level of impulsivity (P=0.002; adjusted OR 6.6; 95% CI 2-20), a higher rate of depressive episodes (P=0.003; adjusted OR 5; 95% CI 1.69-14.2) and more subyndromal symptoms (P=0.007; adjusted OR 5.8; 95% CI 1.63-20). CONCLUSIONS Suicide prevention is an important mental health subject. It would be imperative to include systematic screening for childhood adversities and adequate management of bipolar disorder and impulsivity.
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Zimmerman M. Using Screening Scales for Bipolar Disorder in Epidemiologic Studies: Lessons Not Yet Learned. J Affect Disord 2021; 292:708-713. [PMID: 34161888 DOI: 10.1016/j.jad.2021.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In a recent issue in the journal, Humpston, Bebbington, and Marwaha (2021) reported the results of the first large epidemiological study of bipolar disorder in England. The prevalence estimate of bipolar disorder was based on the Mood Disorders Questionnaire (MDQ), a self-administered screening scale for a lifetime history of mania/hypomania. Humpston and colleagues found that the prevalence of bipolar disorder in England was similar to the rates in other parts of the world, and they stated that most individuals with bipolar disorder in England did not receive treatment for the disorder in the past year. A better understanding of the statistics of screening and the performance of the MDQ would indicate that the conclusions drawn from the epidemiological study are not justified. METHODS I review the principles and statistics of diagnostic screening and how screening is distinguished from case-finding. I then review the performance of the MDQ in the general population and calculate the positive predictive value of the MDQ in the study by Humpston and colleagues. RESULTS The developers of the MDQ reported a sensitivity of 28.1% and specificity of 97.2% in the general population based on a cutoff score of 7. Using this same cutoff, Humpston and colleagues reported the prevalence of "probable" bipolar disorder was 1.7%. Based on these data, the positive predictive value of the MDQ would be only 14.8%. LIMITATIONS Humpson et al. did not compare the MDQ to a diagnostic interview in their study; thus, the performance of the MDQ was estimated from another general population study. CONCLUSIONS When studying a disorder with a relatively low prevalence, it is near impossible for a screening test to have sufficient positive predictive value to be used to validly compare the individuals who do and do not screen positive. Most of the individuals whom Humpston et al. considered to have "probable" bipolar disorder would not have received the diagnosis had they been directly interviewed. Thus, the results of the Humpston et al. study are not a valid indicator of the correlates of bipolar disorder in the general population of England.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI..
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Moitra M, Santomauro D, Degenhardt L, Collins PY, Whiteford H, Vos T, Ferrari A. Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis. J Psychiatr Res 2021; 137:242-249. [PMID: 33714076 PMCID: PMC8095367 DOI: 10.1016/j.jpsychires.2021.02.053] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mental disorders (MDs) are known risk factors for suicide. This systematic review updates the evidence base for this association and improves upon analytic approaches by incorporating study-level and methodological variables to account for measurement error in pooled suicide risk estimates. METHODS A systematic review was conducted to review studies on MDs as risk factors for suicide. Relevant studies were searched using PubMed, Embase, PsychINFO, and existing reviews from 2010 to 19. Studies were eligible if they were longitudinal/case-control studies, representative of the general population, used diagnostic instruments, and quantified suicide risk. The outcome assessed was relative risks (RRs) for suicide due to MDs. A multi-level meta-regression approach was used to obtain pooled RRs adjusted for covariates and between-study effects. FINDINGS We identified 20 eligible studies yielding 69 RRs. Disorder type, age, sex, use of psychological autopsy, study design, and adjustment for confounders were tested as predictors of pooled suicide risk. Overall, all disorders were significant predictors of suicide with predicted adjusted RRs ranging from 4·11 [2·09, 8·09] for dysthymia to 7·64 [4·3, 13·58] for major depressive disorder. INTERPRETATION Our results indicate that MDs are important risk factors for suicide. This systematic review provides pooled RRs that have been adjusted for methodological sources of bias. Findings from our paper may inform suicide prevention strategies as part of national health agendas.
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Affiliation(s)
- Modhurima Moitra
- Institute for Health Metrics and Evaluation, University of Washington, United States; Department of Global Health, University of Washington, United States.
| | - Damian Santomauro
- Institute for Health Metrics and Evaluation, University of Washington, United States; The University of Queensland, School of Public Health, Queensland, Australia; Queensland Centre for Mental Health Research, Queensland, Australia
| | - Louisa Degenhardt
- Institute for Health Metrics and Evaluation, University of Washington, United States; National Drug and Alcohol Research Center, University of New South Wales, Australia
| | - Pamela Y Collins
- Department of Global Health, University of Washington, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, United States
| | - Harvey Whiteford
- Institute for Health Metrics and Evaluation, University of Washington, United States; The University of Queensland, School of Public Health, Queensland, Australia; Queensland Centre for Mental Health Research, Queensland, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, United States
| | - Alize Ferrari
- Institute for Health Metrics and Evaluation, University of Washington, United States; The University of Queensland, School of Public Health, Queensland, Australia; Queensland Centre for Mental Health Research, Queensland, Australia
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32
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Au JS, Martinez de Andino A, Mekawi Y, Silverstein MW, Lamis DA. Latent class analysis of bipolar disorder symptoms and suicidal ideation and behaviors. Bipolar Disord 2021; 23:186-195. [PMID: 32579284 DOI: 10.1111/bdi.12967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED Individuals with bipolar disorder are at increased risk of dying by suicide compared to healthy controls and those with unipolar depression. Previous studies show that depressive symptoms and mixed episodes of mania and depression are related to suicide. However, most of these studies adopt a variable-centered approach to understanding how specific symptoms relate to suicidal ideation, without addressing how these symptoms and symptom profiles relate to suicidal behaviors. OBJECTIVES Using latent class analysis, this study adopts a person-centered approach to examine whether subtypes of patients with bipolar disorder differ in their levels of suicidal ideation and behaviors. METHODS A total of 150 patients from a behavioral health outpatient clinic were recruited. Latent classes were generated based on self reports of their depressive and manic symptoms. RESULTS Five classes of patients with bipolar disorder were identified, namely, a minimal symptom, mania, moderately depressed, severely depressed, and mixed depression-mania subtypes. Those in the severely depressed and mixed depression-mania groups reported significantly higher levels of suicidal ideation and behaviors compared to the other groups. CONCLUSIONS Our findings provide further support for the strong relationship between depressive symptoms and suicidality. These findings are significant as they shed light on the different suicide risk profiles among a heterogenous group of patients with bipolar disorder. Name of clinical trial: Suicidal Behavior in Patients Diagnosed with Bipolar Disorder: The Roles of Biological and Childhood and Adult Environmental Risk Factors. ClinicalTrials.gov Identifier: NCT02604277.
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Affiliation(s)
- Josephine S Au
- Child and Adolescent Psychiatry Division, McLean Hospital/Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ana Martinez de Andino
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Yara Mekawi
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
| | - Madison W Silverstein
- Department of Psychological Sciences, Loyola University New Orleans, New Orleans, LA, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, GA, USA
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Teobaldi E, Albert U, Di Salvo G, Mencacci C, Rosso G, Salvi V, Maina G. Manic-Depressive Cycles in Bipolar Disorder: Clinical and Treatment Implications. Psychopathology 2021; 54:98-105. [PMID: 33626525 DOI: 10.1159/000513314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 11/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cycle patterns of bipolar disorders (BDs) have been previously shown to be associated with clinical characteristics and response to lithium salts. Here, we evaluated the distribution of different types of manic-depressive cycles in a large sample of patients with BD. The associations between a mania-depression-interval (MDI) course and depression-mania-interval (DMI) course with sociodemographic/clinical factors were also assessed in order to define specific clinical profiles. METHODS In this cross-sectional study, 806 patients with BD admitted to the Psychiatric Unit of San Luigi Gonzaga Hospital in Orbassano and Molinette Hospital in Turin, Italy, were recruited. Patients were grouped according to the following course patterns: MDI, DMI, continuous cycling (CC, <4 episodes/year without intervals), rapid cycling (RC, ≥4 episodes/year), and irregular (IRR) cycling. We compared several sociodemographic and clinical variables in an MDI versus DMI course by means of ANOVA and Pearson χ2 with Bonferroni correction. RESULTS Bipolar cycles were distributed as follows: 50.2% IRR course, 31.5% MDI course, 16% DMI course, 1.2% CC, and 1% RC. Compared to DMI course, patients with an MDI course were more often men, younger, with an earlier onset, a manic polarity onset, and more lifetime compulsory admissions. They were more frequently treated with lithium and antipsychotics. Patients with a DMI course had older age at diagnosis and at first mood-stabilizer treatment and were more often misdiagnosed with a major depressive disorder. These patients were more commonly treated with anticonvulsants, and they had more frequently failed treatment trials with lithium salts in the past. CONCLUSION This study supports the utility of classifying BD according to their course patterns. This classification holds prognostic as well as therapeutic implications.
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Affiliation(s)
- Elena Teobaldi
- Department of Neurosciences 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - Umberto Albert
- Department of Medicine, Surgery, and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy.,ASUGI, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gabriele Di Salvo
- Department of Neurosciences 'Rita Levi Montalcini', University of Torino, Turin, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Gianluca Rosso
- Department of Neurosciences 'Rita Levi Montalcini', University of Torino, Turin, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Virginio Salvi
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy,
| | - Giuseppe Maina
- Department of Neurosciences 'Rita Levi Montalcini', University of Torino, Turin, Italy.,Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
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Sobczak AM, Bohaterewicz B, Marek T, Fafrowicz M, Dudek D, Siwek M, Tereszko A, Krupa A, Bryll A, Chrobak AA. Altered Functional Connectivity Differences in Salience Network as a Neuromarker of Suicide Risk in Euthymic Bipolar Disorder Patients. Front Hum Neurosci 2020; 14:585766. [PMID: 33281585 PMCID: PMC7705642 DOI: 10.3389/fnhum.2020.585766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/16/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The occurrence of death by suicide in patients diagnosed with bipolar disorder is as much as 60 times greater than in the general population. Even during the state of euthymia patients are characterized by suicide risk. The aim of the study is to investigate the baseline brain activity in euthymic bipolar disorder patients in regard to suicide risk. We hypothesized that patients compared to healthy control group will demonstrate altered functional connectivity among resting state networks which will be directly related to current suicide risk. Method 41 subjects were enrolled in the study consisting control group (n = 21) and euthymic bipolar disorder patients group (n = 20). Functional magnetic resonance imaging was used to evaluate resting state brain activity and ROI-ROI functional connectivity analysis was performed. Suicidal risk was estimated using The Suicide Behaviors Questionnaire-Revised. Results A two sample t-test revealed decreased functional connectivity between regions involved in the salience network in patients compared to the control group. This decrease was negatively correlated with current suicide risk. Conclusion Obtained results suggest the association between risk of suicide and activity of regions responsible for functions such as learning from mistakes, prospective thinking, and sensory integration.
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Affiliation(s)
- Anna Maria Sobczak
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Bartosz Bohaterewicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland.,Department of Psychology of Individual Differences, Psychological Diagnosis, and Psychometrics, Institute of Psychology, University of Social Sciences and Humanities, Warsaw, Poland
| | - Tadeusz Marek
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Magdalena Fafrowicz
- Department of Cognitive Neuroscience and Neuroergonomics, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland
| | - Dominika Dudek
- Department of Adult Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Marcin Siwek
- Department of Affective Disorders, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Tereszko
- Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Krupa
- Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Amira Bryll
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
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Abstract
OBJECTIVES A narrative review of past, present, and future of lithium use in psychiatry. METHODS The most important references on the topic were reviewed with special emphasis on the author's works. RESULTS The history of medical and psychiatric use of lithium dates back to more than one and a half-century ago. However, modern psychiatric history began with the publication of John Cade, in 1949, showing a therapeutic effect of lithium in mania. Currently, lithium is a drug of choice as a mood-stabilizer for the maintenance treatment of the bipolar disorder. The second most important use of lithium is probably augmentation of antidepressants in treatment-resistant depression. In addition to its mood-stabilizing properties, lithium exerts anti-suicidal, immunomodulatory, and neuroprotective action. The drug may protect against dementia and some promising effects of lithium in neurodegenerative disorders have been observed. CONCLUSION Given the clinical and biological properties of lithium, this drug is presently greatly underutilized in mood disorders. Therefore, the efforts should be undertaken for challenging a skepticism about the use of lithium and optimizing its long-term administration. In such a way, more patients with mood disorders can become the beneficiaries of lithium's therapeutic action. KEY POINTS Lithium is a drug of choice as a mood-stabiliser for the maintenance treatment of bipolar disorder. Augmentation of antidepressants by lithium is one of the best strategies in treatment-resistant depression. Lithium exerts anti-suicidal, immunomodulatory, and neuroprotective action and may protect against dementia. Despite the evidence for the efficacy and added favourable properties, lithium is greatly underutilised in mood disorders. Challenging a scepticism about the use of lithium and optimising its long-term administration can make more patients with mood disorders the beneficiaries of lithium's therapeutic action.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.,Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
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Fan P, Guo X, Qi X, Matharu M, Patel R, Sakolsky D, Kirisci L, Silverstein JC, Wang L. Prediction of Suicide-Related Events by Analyzing Electronic Medical Records from PTSD Patients with Bipolar Disorder. Brain Sci 2020; 10:E784. [PMID: 33121080 PMCID: PMC7692143 DOI: 10.3390/brainsci10110784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Around 800,000 people worldwide die from suicide every year and it's the 10th leading cause of death in the US. It is of great value to build a mathematic model that can accurately predict suicide especially in high-risk populations. Several different ML-based models were trained and evaluated using features obtained from electronic medical records (EMRs). The contribution of each feature was calculated to determine how it impacted the model predictions. The best-performing model was selected for analysis and decomposition. Random forest showed the best performance with true positive rates (TPR) and positive predictive values (PPV) of greater than 80%. The use of Sertraline, Fentanyl, Aripiprazole, Lamotrigine, and Tramadol were strong indicators for no SREs within one year. The use of Haloperidol, Trazodone and Citalopram, a diagnosis of autistic disorder, schizophrenic disorder, or substance use disorder at the time of a diagnosis of both PTSD and bipolar disorder, predicted the onset of SREs within one year. The use of Trazodone and Citalopram at baseline predicted the onset of SREs within one year. Additional features with potential protective or hazardous effects for SREs were identified by the model. We constructed an ML-based model that was successful in identifying patients in a subpopulation at high-risk for SREs within a year of diagnosis of both PTSD and bipolar disorder. The model also provides feature decompositions to guide mechanism studies. The validation of this model with additional EMR datasets will be of great value in resource allocation and clinical decision making.
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Affiliation(s)
- Peihao Fan
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15206, USA; (P.F.); (X.G.); (X.Q.)
| | - Xiaojiang Guo
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15206, USA; (P.F.); (X.G.); (X.Q.)
| | - Xiguang Qi
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15206, USA; (P.F.); (X.G.); (X.Q.)
| | - Mallika Matharu
- Department of Statistics and Department of Economics, University of Pittsburgh School of Arts & Sciences, Pittsburgh, PA 15213, USA;
| | - Ravi Patel
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15213, USA;
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Levent Kirisci
- Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15213, USA
| | - Jonathan C. Silverstein
- Department of Biomedical Informatics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Lirong Wang
- Department of Pharmaceutical Sciences, Computational Chemical Genomics Screening Center, University of Pittsburgh School of Pharmacy, Pittsburgh, PA 15206, USA; (P.F.); (X.G.); (X.Q.)
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Iliachenko EK, Ragazan DC, Eberhard J, Berge J. Suicide mortality after discharge from inpatient care for bipolar disorder: A 14-year Swedish national registry study. J Psychiatr Res 2020; 127:20-27. [PMID: 32450359 DOI: 10.1016/j.jpsychires.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21-0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48-1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41-3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.
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Affiliation(s)
- Elena K Iliachenko
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Dragos C Ragazan
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Jonas Eberhard
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden.
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Tamura JK, McIntyre RS. Current and Future Vistas in Bipolar Disorder. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Şenormancı G, Güçlü O, Özben İ, Karakaya FN, Şenormancı Ö. Resilience and insight in euthymic patients with bipolar disorder. J Affect Disord 2020; 266:402-412. [PMID: 32056906 DOI: 10.1016/j.jad.2020.01.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 01/05/2020] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The relationship between resilience and insight may be of potential importance for coping with stress in bipolar disorder (BD). The aim of this study was to investigate if there was a relation between insight and resilience in euthymic patients with BD and also to analyze the associations between resilience, impulsivity, aggression, alcohol use and affective temperament. METHODS 142 patients with BD type I in remission period were involved. Resilience Scale for Adults-Turkish version, Schedule for Assessment of Insight, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, Michigan Alcoholism Screening Test were used. RESULTS Total insight scores were negatively correlated with the scores of perception of future. As distinct from other subscales of resilience, family cohesion had independent significant associations with insight in relabelling of psychotic experiences and attention impulsivity. There was no relationship between total insight and total resilience scores. Resilience scores were negatively correlated with number of depressive episodes and number of suicide attempts. Degree of aggression, degree of impulsivity, scores of depressive and hyperthymic temperament significantly predicted resilience. LIMITATIONS Recruitment of patients from a tertiary centre limits the generalizability of the findings. CONCLUSIONS Better insight was related to negative perception of the future and did not have significant associations with total resilience. Number of depressive episodes, number of past suicide attempts correlated with resilience, emphasizing the importance of interventions to increase resilience in BD.
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Affiliation(s)
- Güliz Şenormancı
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey.
| | - Oya Güçlü
- Neurology and Neurosurgery, Department of Psychiatry Bakirkoy Training and Research Hospital for Psychiatry, Istanbul, Turkey
| | - İlker Özben
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey
| | - Fatma Nur Karakaya
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey
| | - Ömer Şenormancı
- University of Health Sciences Bursa Yüksek Ihtisas Training and Research Hospital, 16240 Nilüfer, Bursa, Turkey
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Rybakowski JK. Lithium treatment in the era of personalized medicine. Drug Dev Res 2020; 82:621-627. [PMID: 32207857 DOI: 10.1002/ddr.21660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
In 1949, an Australian psychiatrist, John Cade, reported on the antimanic efficacy of lithium carbonate, which is regarded as an introduction of lithium into contemporary psychiatry. Since the 1960s, lithium has been a precursor of mood stabilizers and has become first-choice drug for the prevention of affective episodes in mood disorders. For nearly four decades, lithium has also been used for the augmentation of antidepressant drugs in treatment-resistant depression. The knowledge of clinical and biological factors connected with the capability of long-term lithium treatment to prevent manic and depressive recurrences makes an important element of the personalized medicine of mood disorders. Excellent prophylactic lithium responders can be characterized by distinct mood episodes, with full remissions between them, the absence of other psychiatric morbidity, and the family history of bipolar illness. In recent years, many other clinical and biological factors connected with such a response have been identified, helping to select the best candidates for lithium prophylaxis. The antisuicidal effect of lithium during its long-term administration has been demonstrated and should also be taken into account as the element of personalized medicine for the pharmacological prophylaxis of patients with mood disorders. Several studies pertaining to personalized medicine were also dedicated to lithium treatment of acute mood episodes. Lithium still has a value in the treatment of mania and bipolar depression. However, it seems that the more important indication would be the augmentation of antidepressant drugs in treatment-resistant depression. The factors connected with the efficacy of lithium in these conditions are reviewed.
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Affiliation(s)
- Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.,Department of Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
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Psychiatric diagnosis, gender, aggression, and mode of attempt in patients with single versus repeated suicide attempts. Psychiatry Res 2020; 284:112747. [PMID: 31927168 DOI: 10.1016/j.psychres.2020.112747] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/01/2019] [Accepted: 01/01/2020] [Indexed: 12/31/2022]
Abstract
There is evidence that patients with multiple suicide attempts in their history are at greater risk to repeat attempt and eventually die by suicide compared to those with a single attempt. This cross-sectional study aimed to explore possible differences in clinical characteristics between patients with a single attempt and patients with repeated attempts. Two hundred thirty one patients hospitalised in psychiatric department after suicide attempt were studied. Comparisons were made in relation to age, gender, psychiatric diagnosis, aggression, depression severity, suicide intent and mode of attempt. Highest frequencies of patients with repeated attempts were found for bipolar disorder (69%) and lowest for adjustment/personality disorders (39%). In patients with repeated attempts, female gender was associated with non-violent attempt mode. Depressive symptomatology was higher in patients with repeated attempts among females. In patients with depression those with repeated attempts were younger than patients with single attempt. In patients with mood disorders, total aggression and hostility scores were higher in females with repeated attempts but not in males. Psychiatric diagnosis, gender and attempt mode are features that differentiate patients with single and repeated attempts and should be considered to identify patients at increased risk to repeat attempt and design effective prevention interventions.
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Abstract
PURPOSE OF REVIEW Bipolar disorder has the highest rate of suicide of all psychiatric conditions and is approximately 20-30 times that of the general population. The purpose of this review is to discuss findings relevant to bipolar disorder and suicide. RECENT FINDINGS Risk factors include male gender, living alone, divorced, no children, Caucasian, younger age (< 35 years), elderly age (> 75 years), unemployment, and a personal history of suicide attempt and family history of suicide attempt or suicide completion, as well as predominant depressive polarity. Suicide is associated with the depressed or mixed subtypes, not mania. Although there are emerging treatments for bipolar depression, such as ketamine and TMS, lithium remains the only medication associated with lowered suicide rates in bipolar disorder. Understanding clinical and demographic risk factors for suicide in bipolar disorder remains the best way to prevent suicidal behavior. Early intervention and treatment with anti-suicidal medications, such as lithium, along with close observation and follow-up is the best way to mitigate suicide in patients with bipolar disorder.
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García-Jiménez J, Gutiérrez-Rojas L, Jiménez-Fernández S, González-Domenech PJ, Carretero MD, Gurpegui M. Features Associated With Depressive Predominant Polarity and Early Illness Onset in Patients With Bipolar Disorder. Front Psychiatry 2020; 11:584501. [PMID: 33304285 PMCID: PMC7701086 DOI: 10.3389/fpsyt.2020.584501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/15/2020] [Indexed: 12/19/2022] Open
Abstract
Objective: The aim of this study is to determine the prevalence of three possible diagnostic specifiers, namely predominant polarity (PP) throughout illness, polarity of the first episode and early age at onset, in a sample of bipolar disorder (BD) patients and their association with important socio-demographic, clinical and course-of-illness variables. Methods: A retrospective and naturalistic study on 108 BD outpatients, who were classified according to the PP, polarity of the first episode and early age at onset (≤ 20 years) [vs. late (>20 years)] and were characterized by their demographics, clinical data, functionality and social support, among others features. After bivariate analyses, those variables showing certain association (P value < 0.25) with the three dependent variables were entered in logistic regression backward selection procedures to identify the variables independently associated with the PP, polarity of the first episode and early age at onset. Results: The sample consisted of 75 women ad 33 men, 74% with type I BD and 26% with type II. Around 70% had depressive PP, onset with a depressive episode and onset after age 20. Depressive PP was independently associated with depressive onset, higher score on the CGI severity scale and work disability. Onset with depressive episode was associated with type II BD, longer diagnostic delay and higher score on family disability. Early age at onset (≤ 20 years) was associate with younger age, longer diagnostic delay, presence of ever psychotic symptoms, current use of antipsychotic drugs and higher social support score. Conclusions: The results of this study show that BD patients with depressive PP, onset with depression and early age at onset may represent greater severity, because they are frequently associated with variables that worsen the prognosis. Our findings match up with the conclusions of two systematic reviews and we also include a disability factor (at family and work) that has not been previously reported. This work contributes to the use of polarity and age at onset in BD patients, as it can become a useful instrument in the prognostic and therapeutic applications.
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Affiliation(s)
- Jesús García-Jiménez
- Southern Mental Health Clinical Management Unit, Santa Ana Hospital, Motril, Spain
| | - Luis Gutiérrez-Rojas
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Granada Mental Health Clinical Management Unit, Hospital Clínico San Cecilio, Granada, Spain
| | - Sara Jiménez-Fernández
- Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Child and Adolescent Mental Health Service, Jaén University Hospital Complex, Jaén, Spain
| | - Pablo José González-Domenech
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
| | | | - Manuel Gurpegui
- Department of Psychiatry, University of Granada, Granada, Spain.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain
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Wang D, Ma J, Tan L, Chen Y, Zhou X, Wang H, Guo J, Li X, Liu X. Characteristics of help-seeking behavior among bipolar disorder patients: A study in Hunan, China. Medicine (Baltimore) 2019; 98:e17687. [PMID: 31725611 PMCID: PMC6867767 DOI: 10.1097/md.0000000000017687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To analyze the factors that affecting the help-seeking behavior of bipolar disorder (BD) patients by conducting interviews BD individuals in Hunan province of China.In 2015, 72,999 people from 123 counties of Hunan province of China were interviewed through multistage stratified random sampling. Twelve items of general health questionnaire (GHQ-12) and abnormal behavioral clue questionnaire were used as screening tools. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) (SCID) was used as a diagnostic tool.Among the 75 BD patients, 36% (27/75) sought help. Compared with help-seekers, non-help-seekers were more likely to be older, divorced, or widowed, mostly illiterate or elementary education, family monthly income at least 3000 ¥, more physically consulted in the past year, able to effective work or study, at a stable illness status. 70.4% help-seekers firstly sought help from a medical institution. The main reasons that patients did not seek help were economic problem, did not know where to seek help, unsatisfied with medical services, afraid of mental health stigma, and other problems, such as traffic inconvenience.Non-help-seekers were faced with more difficulties in their social functions and social interactions.
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Affiliation(s)
- Dongxin Wang
- Hunan Institute of Mental Health, Brain Hospital of Hunan Province
| | - Jing Ma
- Hunan Institute of Mental Health, Brain Hospital of Hunan Province
| | - Lihong Tan
- Hunan Institute of Mental Health, Brain Hospital of Hunan Province
| | - Yan Chen
- Department of Disease Control, Health and Family Planning Commission of Hunan Province
| | - Xuhui Zhou
- Hunan Institute of Mental Health, Brain Hospital of Hunan Province
| | - Huiying Wang
- Social Health Management, XiangYa School of Public Health & Central South University, Changsha, P.R. China
| | - Jing Guo
- Social Health Management, XiangYa School of Public Health & Central South University, Changsha, P.R. China
| | - Xiaosong Li
- Hunan Institute of Mental Health, Brain Hospital of Hunan Province
| | - Xuejun Liu
- Hunan Institute of Mental Health, Brain Hospital of Hunan Province
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Cato V, Holländare F, Nordenskjöld A, Sellin T. Association between benzodiazepines and suicide risk: a matched case-control study. BMC Psychiatry 2019; 19:317. [PMID: 31655565 PMCID: PMC6815437 DOI: 10.1186/s12888-019-2312-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 10/09/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND It is unclear whether benzodiazepines increase the risk of suicide. The aim of this study was to test the hypothesis that benzodiazepines are associated with an increased risk of suicide, by comparing psychopharmacological interventions between psychiatric patients who committed suicide and a group of matched controls. METHODS The case group comprised 154 psychiatric patients (101 men, 53 women; age range: 13-96 years) who had committed suicide in Örebro County, Sweden. Control psychiatric patients matched by age, sex, and main psychiatric diagnosis were selected for each case. Binary logistic regression was used to calculate odds ratios in unadjusted and adjusted models. RESULTS Benzodiazepine prescriptions were more common among cases than controls (65/154 [42.2%] versus 43/154 [27.9%], p = 0.009, odds ratio: 1.89 [95% CI: 1.17-3.03]). This association remained significant in a model adjusted for previous suicide attempts and somatic hospitalizations (odds ratio: 1.83 [95% CI: 1.06-3.14]). No statistically significant differences were seen between the groups in the use of any other subtype of psychopharmaceutical agent. CONCLUSIONS These data indicate that benzodiazepine use may increase the risk of suicide. However, this study is limited by the potential for indication bias.
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Affiliation(s)
- Ville Cato
- 0000 0001 0738 8966grid.15895.30School of Medical Sciences, Örebro University, Örebro, SE-701 82 Örebro, Sweden
| | - Fredrik Holländare
- 0000 0001 0738 8966grid.15895.30University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Tabita Sellin
- 0000 0001 0738 8966grid.15895.30University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden
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Cognitive impairment in late life bipolar disorder: Risk factors and clinical outcomes. J Affect Disord 2019; 257:166-172. [PMID: 31301619 DOI: 10.1016/j.jad.2019.07.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/09/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Late Life Bipolar Disorder (LLBD) is associated with a high prevalence of cognitive impairments, but few studies have examined their risk factors and clinical correlates METHODS: Participants with bipolar disorder older than 60 (n = 86) were recruited from psychiatric outpatient and inpatients units. Patients were assessed with various instruments, including the Clinical Dementia Rating scale, the Montreal Cognitive Assessment and the Cumulative Illness Rating Scale. The distribution of disorder-specific and general risk factors was compared between patients with LLBD plus cognitive impairments (mild cognitive impairment or dementia) and those with LLBD but no cognitive impairment. Analyses were first conducted at the bivariate level, then using multiple regression. The association with disability, aggressive behavior and suicidal ideation was also explored. RESULTS Cognitive impairments in LLBD were associated with a diagnosis of type 1 bipolar disorder (OR = 6.40, 95%CI: 1.84 - 22.31, p = 0.004), fewer years of education (OR = 0.79, 95%CI: 0.69 - 0.91, p = 0.001) and higher severity of physical diseases (OR 26.54, 95%CI: 2.07 - 340.37, p = 0.01). Moreover, cognitive impairments were associated with an increased likelihood of disability and recent aggressive behavior, but not suicidal ideation. LIMITATIONS retrospective design, conflation of MCI and dementia, not all subjects were in euthymia CONCLUSIONS: In LLBD, the presence of cognitive impairments was associated with a diagnosis of type I bipolar disorder, lower education and more severe physical comorbidities. In turn, MCI or dementia were associated with increased disability and aggressive behavior. These findings may aid the identification of patients at risk for cognitive deterioration in everyday clinical practice.
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Cesur E, Şahmelikoğlu Onur Ö, Erten E. Differences in metacognitive beliefs among patients with bipolar disorder with or without previous suicide attempts. Nord J Psychiatry 2019; 73:433-440. [PMID: 31393750 DOI: 10.1080/08039488.2019.1649722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: The aim of this study is to compare differences in metacognitive beliefs between patients with bipolar disorder type I (BPDI) with previous suicide attempts (BPDI+), those without suicide attempts (BPDI-), and a control group. It also discusses the relationship between metacognitive beliefs and suicidal behavioral parameters. Materials and methods: The study included 72 BPDI+ and 73 BPDI- euthymic patients and 86 healthy age- and gender-matched individuals. All participants completed a sociodemographic data form, the Beck Depression Inventory, Metacognition Questionnaire-30 (MCQ-30), Suicide Behaviors Questionnaire, and Structured Clinical Interview for DSM-IV Axis I. In addition, the Young Mania Rating Scale was used for the patient groups. Results: Both the BPDI+ and BPDI- patients had higher MCQ-30 scores than the control group (p < .01). Scores for the 'need to control thoughts' subscale were higher in the BPDI+ group than in the BPDI- group and were also higher in both the BPDI+ and BPDI- groups compared to the control group (p < .01). In addition, the 'cognitive self-consciousness' sub-scores of the BPDI- group were higher than those of the BPDI+ and the control group. Conclusion: The scores of 'cognitive self-consciousness' and 'need to control thoughts' vary across BPDI+ and BPDI- patients. It seems important to consider metacognitive beliefs regarding 'need to control thoughts' and 'cognitive self-consciousness' in terms of suicide prevention.
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Affiliation(s)
- Ender Cesur
- Psychiatry Clinic, Bitlis State Hospital , Bitlis , Turkey
| | - Özge Şahmelikoğlu Onur
- Third Psychiatry Clinic, Bakirkoy Research & Training Hospital for Psychiatry, Neurology and Neurosurgery , Istanbul , Turkey
| | - Evrim Erten
- Medical Park Bahcelievler Hospital , Istanbul , Turkey
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48
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Icick R, Melle I, Etain B, Ringen PA, Aminoff SR, Leboyer M, Aas M, Henry C, Bjella TD, Andreassen OA, Bellivier F, Lagerberg TV. Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. J Affect Disord 2019; 256:348-357. [PMID: 31202989 DOI: 10.1016/j.jad.2019.05.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. METHODS 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. RESULTS 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. LIMITATIONS Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. CONCLUSION Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
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Affiliation(s)
- R Icick
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France.
| | - I Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Etain
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - P A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - S R Aminoff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Leboyer
- FondaMental Foundation, Créteil F-94000, France; Inserm U955, Psychiatric Genetics Team, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Henri Mondor, DHU PePsy, Psychiatry Center, Créteil F-94000, France
| | - M Aas
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France
| | - T D Bjella
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - T V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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49
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Dome P, Rihmer Z, Gonda X. Suicide Risk in Bipolar Disorder: A Brief Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E403. [PMID: 31344941 PMCID: PMC6723289 DOI: 10.3390/medicina55080403] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
Bipolar disorders (BDs) are prevalent mental health illnesses that affect about 1-5% of the total population, have a chronic course and are associated with a markedly elevated premature mortality. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, the rate of suicide among BD patients is approximately 10-30 times higher than the corresponding rate in the general population. Extant research found that up to 20% of (mostly untreated) BD subjects end their life by suicide, and 20-60% of them attempt suicide at least one in their lifetime. In our paper we briefly recapitulate the current knowledge on the epidemiological aspects of suicide in BD as well as factors associated with suicidal risk in BD. Furthermore, we also discuss concisely the possible means of suicide prevention in BD.
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Affiliation(s)
- Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary.
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary.
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary
- MTA-SE Neuropsychopharmacology, Neurochemistry Research Group, Hungarian Academy of Sciences, 1089 Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, 1089 Budapest, Hungary
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50
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Fico G, Caivano V, Zinno F, Carfagno M, Steardo LJ, Sampogna G, Luciano M, Fiorillo A. Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E390. [PMID: 31331102 PMCID: PMC6681298 DOI: 10.3390/medicina55070390] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory, revised version (TCI-R). The sample was divided into two groups on the basis of a positive history for suicidal attempts and the suicidal group was further divided into two subgroups according to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamental characteristics are associated with violent suicide attempts, suggesting the importance of affective temperaments in the clinical management of patients with BPI.
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Affiliation(s)
- Giovanna Fico
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy.
| | - Vito Caivano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Francesca Zinno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Luca Jr Steardo
- Department of Health Sciences, Psychiatric Unit, University Magna Graecia of Catanzaro, Viale Europa, 88100 Catanzaro CZ, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Largo Madonna Delle Grazie, 80139 Naples, Italy
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