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Dev DA, Le GH, Kwan ATH, Wong S, Arulmozhi A, Ceban F, Teopiz KM, Meshkat S, Rosenblat JD, Guillen-Burgos HF, Rhee TG, Ho RC, Cao B, d'Andrea G, Sundberg I, McIntyre RS. Comparing suicide completion rates in bipolar I versus bipolar II disorder: A systematic review and meta-analysis. J Affect Disord 2024; 361:480-488. [PMID: 38901691 DOI: 10.1016/j.jad.2024.06.045] [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: 09/23/2023] [Revised: 06/03/2024] [Accepted: 06/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Bipolar disorder (BD) has a high disease burden and the highest mortality risk in BD comes from suicide. Bipolar disorder type II (BD-II) has been described as a milder form of bipolar disorder; however, extant literature is inconsistent with this description and instead describe illness burden and notably suicidality comparable to persons with bipolar I disorder (BD-I). Towards quantifying the hazard of BD-II, herein we aim via systematic review and meta-analysis to evaluate the rates of completed suicide in BD-I and BD-II. METHOD We conducted a literature search on PubMed, OVID (Embase, Medline) and PsychINFO databases from inception to June 30th, 2023, according to PRISMA guidelines. Articles were selected based on the predetermined eligibility criteria. A meta-analysis was performed, comparing the risk of completed suicide between individuals diagnosed with BD-I to BD-II. RESULTS Four out of eight studies reported higher suicide completion rates in persons living with BD-II when compared to persons living with BD-I; however, two of the studies reported non-significance. Two studies reported significantly higher suicide completion rates for BD-I than BD-II. The pooled odds ratio of BD-II suicide rates to BD-I was 1.00 [95 % CI = 0.75, 1.34]. LIMITATIONS The overarching limitation is the small number of studies and heterogeneity of studies that report on suicide completion in BD-I and BD-II. CONCLUSION Our study underscores the severity of BD-II, with a risk for suicide not dissimilar from BD-I. The greater propensity to depression, comorbidity and rapid-cycling course reported in BD-II are contributing factors to the significant mortality hazard in BD-II.
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Affiliation(s)
- Donovan A Dev
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; School of Medicine, University College Dublin, Dublin, Ireland; Department of Neuroscience Imaging and Clinical Sciences, University G d'Annunzio, Chieti, Italy.
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Sabrina Wong
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Akhilan Arulmozhi
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Felicia Ceban
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada.
| | - Shakila Meshkat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.
| | - Hernan F Guillen-Burgos
- Center for Clinical and Translational Research, Universidad Simón Bolívar, Barranquilla, Colombia; Center for Clinical and Translational Research, Faculty of Medicine, Universidad El Bosque, Bogotá D.C., Colombia; Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá D.C., Colombia..
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, USA.
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 117599, Singapore.; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore.
| | - Bing Cao
- Key Laboratory of Cognition and Personality (SWU), Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, PR China.
| | - Giacomo d'Andrea
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Isak Sundberg
- Department of Neuroscience Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada; School of Medicine, University College Dublin, Dublin, Ireland; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Kim S, Dunn N, Moon K, Casement MD, Nam Y, Yeom JW, Cho CH, Lee HJ. Childhood maltreatment and suicide attempts in major depression and bipolar disorders in South Korea: A prospective nationwide cohort study. J Affect Disord 2024; 361:120-127. [PMID: 38851432 DOI: 10.1016/j.jad.2024.06.012] [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: 03/09/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Childhood maltreatment (CM) is prevalent among patients with mood disorders and considered an important risk factor for suicide in the general population. Despite mood disorders being implicated in up to 60 % of completed suicides, the predictive role of CM on suicide attempt (SA) among early mood disorder patients remains poorly understood. METHODS We enrolled 480 participants diagnosed with early-onset major depressive disorder (MDD), bipolar I disorder (BD I), and bipolar II disorder (BD II). Over an average of 60 weeks, participants underwent follow-up assessments at 12-week intervals. Using multivariate logistic regression, we examined the association between CM and SA history at baseline. Further, the Cox proportional hazard model assessed the predictive role of childhood maltreatment in SA during follow-up. RESULTS At baseline, 38 % of the total participants reported SA history, with a follow-up prevalence of 10 %. Childhood maltreatment was significantly associated with past SAs and was a robust predictor of future SA, adjusting for relevant clinical risk factors. Emotional abuse and sexual abuse related to SA history, and physical abuse increased future SA risk. LIMITATIONS Potential biases in reporting SA and childhood maltreatment, along with unexplored factors such as additional environmental and familial risks, may affect the study's findings. CONCLUSIONS Childhood maltreatment emerged as a robust predictor of SA among early-onset mood disorder patients. Systematic evaluation of CM early in the clinical process may be crucial for effective risk management. Additionally, our findings highlight the importance of implementing proactive interventions for CM to prevent the onset of adverse psychological trajectories.
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Affiliation(s)
- Sojeong Kim
- Department of Psychology, University of Oregon, Eugene, USA
| | - Natalie Dunn
- Department of Psychology, University of Oregon, Eugene, USA
| | - Kibum Moon
- Department of Psychology, Georgetown University, Washington, DC, USA
| | | | - Yaerim Nam
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Ji Won Yeom
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea; Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea; Korea University Chronobiology Institute, Seoul, Republic of Korea.
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Yang JH, Park CHK, Rhee SJ, Kang DH, Kim MJ, Lee HJ, Lee SY, Shim SH, Moon JJ, Cho SJ, Kim SG, Kim MH, Lee J, Kang WS, Yoo J, Lee WY, Ahn YM. Psychotropic Medications Promote Time-Dependent Reduction of Suicidal Ideation in Mood Disorder: A Prospective Cohort Study. J Korean Med Sci 2024; 39:e226. [PMID: 39137811 PMCID: PMC11319105 DOI: 10.3346/jkms.2024.39.e226] [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: 03/06/2024] [Accepted: 06/24/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Despite a plethora of research on the topic, there is still no solid evidence that pharmacological treatment actually reduces the risk of suicide in patients with mental illness. In this study, we aimed to assess the effect of psychotropic medications on suicidal ideation in patients with major depressive disorder (MDD) and bipolar disorder (BPD) in two age groups: less than 25 years and 25 years and older. METHODS We analyzed 312 patients with mood disorders with current suicidal thoughts or recent suicide attempts. We followed the participants from baseline for 6 months and assessed changes in suicidal ideation with Columbia-Suicide Severity Rating Scale (C-SSRS). The effect of psychotropic drug administration on suicidal ideation over time was analyzed using a linear mixed model. RESULTS In patients aged 25 years and older with mood disorders, suicidal ideation was more severe when using psychotropic drugs than when not using them. However, suicidal ideation decreased rapidly over time. The time-dependent reduction in suicidal ideation was accelerated when using antidepressants and sedatives/hypnotics in adult MDD, and when using mood stabilizers in adult BPD. However, this effect was not observed in participants aged less than 25 years. CONCLUSION Adequate psychotropic medication may reduce suicidal ideation in patients with mood disorders aged 25 years and older. Additional research on psychotropic drugs is needed to effectively reduce the risk of suicide among children and adolescents with mood disorders.
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Affiliation(s)
- Jeong Hun Yang
- Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Dae Hun Kang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jeong Lee
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Psychiatry and Behavioral Science, National Cancer Center, Goyang, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University, Cheonan, Korea
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Won Sub Kang
- Department of Psychiatry, Kyung Hee University Hospital, Seoul, Korea
| | - Jieun Yoo
- College of Social Sciences, Yonsei University, Seoul, Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yong Min Ahn
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Institute of Human Behavioral Medicine, Seoul National University Medical Research Center, Seoul, Korea.
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Jiang Y, Zhou Y, Xie Y, Zhou J, Cai M, Tang J, Liu F, Ma J, Liu H. Functional magnetic resonance imaging alternations in suicide attempts individuals and their association with gene expression. Neuroimage Clin 2024; 43:103645. [PMID: 39059208 PMCID: PMC11326948 DOI: 10.1016/j.nicl.2024.103645] [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: 05/27/2024] [Revised: 06/29/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Functional Magnetic Resonance Imaging (fMRI) has shown brain activity alterations in individuals with a history of attempted suicide (SA) who are diagnosed with depression disorder (DD) or bipolar disorder (BD). However, patterns of spontaneous brain activity and their genetic correlations need further investigation. METHODS A voxel-based meta-analysis of 19 studies including 26 datasets, involving 742 patients with a history of SA and 978 controls (both nonsuicidal patients and healthy controls) was conducted. We examined fMRI changes in SA patients and analyzed the association between these changes and gene expression profiles using data from the Allen Human Brain Atlas by partial least squares regression analysis. RESULTS SA patients demonstrated increased spontaneous brain activity in several brain regions including the bilateral inferior temporal gyrus, hippocampus, fusiform gyrus, and right insula, and decreased activity in areas like the bilateral paracentral lobule and inferior frontal gyrus. Additionally, 5,077 genes were identified, exhibiting expression patterns associated with SA-related fMRI alterations. Functional enrichment analyses demonstrated that these SA-related genes were enriched for biological functions including glutamatergic synapse and mitochondrial structure. Concurrently, specific expression analyses showed that these genes were specifically expressed in the brain tissue, in neurons cells, and during early developmental periods. CONCLUSION Our findings suggest a neurobiological basis for fMRI abnormalities in SA patients with DD or BD, potentially guiding future genetic and therapeutic research.
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Affiliation(s)
- Yurong Jiang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yujing Zhou
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, 116000 Dalian, Liaoning, China
| | - Yingying Xie
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Junzi Zhou
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Mengjing Cai
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jie Tang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feng Liu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Juanwei Ma
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Huaigui Liu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China.
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Tondo L, Baldessarini RJ. Prevention of suicidal behavior with lithium treatment in patients with recurrent mood disorders. Int J Bipolar Disord 2024; 12:6. [PMID: 38460088 PMCID: PMC10924823 DOI: 10.1186/s40345-024-00326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/02/2024] [Indexed: 03/11/2024] Open
Abstract
Suicidal behavior is more prevalent in bipolar disorders than in other psychiatric illnesses. In the last thirty years evidence has emerged to indicate that long-term treatment of bipolar disorder patients with lithium may reduce risk of suicide and attempts, with possibly similar benefits in recurrent major depressive disorder. We review and update selected research literature on effects of lithium treatment in reducing suicidal behavior and consider proposals that higher levels of lithium in drinking water may be associated with lower suicide rates. We summarize results of a growing number of randomized, controlled studies of lithium treatment for suicide prevention including comparisons with placebos or alternative treatments, and comment on the severe challenges of such trials. The basis of a proposed protective effect of lithium against suicidal behaviors remains uncertain but may include protective effects against recurrences of depressive phases of mood disorders, especially with mixed features or agitation, and possibly through beneficial effects on impulsivity, agitation and dysphoric mood.
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Affiliation(s)
- Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA.
- Lucio Bini Mood Disorder Centers, Centro Lucio Bini, 42 Via Crescenzio, Cagliari and Rome, 00193, Rome, Italy.
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
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Iordache AM, Voica C, Roba C, Nechita C. Lithium Content and Its Nutritional Beneficence, Dietary Intake, and Impact on Human Health in Edibles from the Romanian Market. Foods 2024; 13:592. [PMID: 38397569 PMCID: PMC10888284 DOI: 10.3390/foods13040592] [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: 01/11/2024] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Lithium (Li) is present in human nutrition based on food intake, and several studies recommend it for treating mood disorders, even if the biological proprieties and biochemical mechanisms represent the basis for its use as an essential element. The Li content was evaluated using the inductively coupled plasma mass spectrometry technique (ICP-MS) in 1071 food and beverage samples from the Romanian market. The results show that Li had a decreasing mean concentration in the food samples as follows: vegetables leafy > bulbous > fructose > leguminous > egg whites > root vegetables > milk products > egg yolks > meats. Approximately a quarter of all data from each dataset category was extreme values (range between the third quartile and maximum value), with only 10% below the detection limit. Mean Li concentration indicated higher values in red wine, white wines, beers, and fruit juice and lower in ciders and bottled waters. A particular interest was addressed to plants for teas and coffee seeds, which showed narrow amounts of Li. For both food and beverages, two similar matrices, including egg whites and yolks and white and red wines, were found to have significant differences, which explains the high variability of Li uptake in various matrices. For 99.65% of the analyzed samples, the estimated daily intake of Li was below the provisional subchronic and chronic reference dose (2 µg/kgbw/day) for adverse effects in several organs and systems. Even so, a risk occurs in consuming bulbous vegetables (Li > 13.47 mg/kg) and fructose solano vegetables (Li > 11.33 mg/kg). The present study's findings indicate that ingesting most of the analyzed beverages and food samples could be considered safe, even if future studies regarding Li content, nutritional aspects, and human cohort diseases must be conducted.
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Affiliation(s)
- Andreea Maria Iordache
- National Research and Development Institute for Cryogenics and Isotopic Technologies—ICSI Ramnicu Valcea, 4 Uzinei Street, 240050 Ramnicu Valcea, Romania;
| | - Cezara Voica
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat St., 400293 Cluj-Napoca, Romania
| | - Carmen Roba
- Faculty of Environmental Science and Engineering, Babes-Bolyai University, 30 Fântânele Street, 400294 400535 Cluj-Napoca, Romania;
| | - Constantin Nechita
- National Research and Development Institute for Forestry “Marin Drăcea”—INCDS, 128 Boulvard Eroilor, 077190 Voluntari, Romania
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Olié E, Lengvenyte A, Courtet P. [How can ketamine be used to manage suicidal risk?]. Biol Aujourdhui 2023; 217:157-160. [PMID: 38018943 DOI: 10.1051/jbio/2023029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Indexed: 11/30/2023]
Abstract
In France, suicidal behaviors remain a major public health issue. Depressed patients with suicidal ideation have more severe depressive symptoms, a more unfavorable disease course, and a greater number of suicide attempts than patients without suicidal ideation. Unfortunately, conventional antidepressants tend to be less effective in patients with suicidal tendencies than in those without. Nevertheless, promising advancements have emerged with the use of ketamine, which has shown significant and rapid efficacy in reducing the intensity of suicidal ideation in depressed patients within the first 72 h after its administration. Several mechanisms are potentially involved: (1) reduction of anhedonia. It has been demonstrated that ketamine reduces both anhedonia and suicidal ideation. In depressed patients, the reduction of anhedonia observed 2 h after ketamine administration is associated with metabolic changes in the anterior cingulate cortex involved in suicidal ideation; (2) activation of neuroplasticity cascades. The reduction in suicidal ideation within 24 h following ketamine administration is correlated with changes in plasma BDNF levels and is modulated by the Val66Met functional polymorphism of the BDNF gene. Moreover, preclinical and clinical studies have shown that ketamine induces functional and connectivity changes in the prefrontal and anterior cingulate regions, which are strongly implicated in suicidal behaviors; (3) reduction of inflammation. It is now widely accepted that suicidal behaviors are associated with low-grade inflammation, and with elevated quinolinic acid and reduced kynurenic acid levels. Interestingly, predictors of a reduction in suicidal ideation after ketamine infusion include initial severity of suicidal thoughts and depression, as well as baseline blood levels of kynurenic acid; (4) involvement of the opioidergic system. Post-mortem studies have indicated alterations in the opioidergic system related to suicidal behaviors. A recent study suggested that the antisuicidal effect of ketamine may depend on this system because naltrexone, an antagonist of mu opioid receptors, abolished the typical antidepressant effect and reduction in suicidal ideation observed following ketamine administration. In conclusion, ketamine exhibits promising potential in mitigating suicidal ideation - its effects are specific, rapid, albeit temporary. The suggested mechanisms driving its efficacy are multifaceted. Nevertheless, it is yet to be determined whether ketamine administration can effectively prevent suicidal behaviors.
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Affiliation(s)
- Emilie Olié
- Département Urgences et Post-Urgences Psychiatriques, CHU Lapeyronie, Hôpital Lapeyronie, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Aisté Lengvenyte
- Département Urgences et Post-Urgences Psychiatriques, CHU Lapeyronie, Hôpital Lapeyronie, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - Philippe Courtet
- Département Urgences et Post-Urgences Psychiatriques, CHU Lapeyronie, Hôpital Lapeyronie, 371 avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
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Biazus TB, Beraldi GH, Tokeshi L, Rotenberg LDS, Dragioti E, Carvalho AF, Solmi M, Lafer B. All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry 2023; 28:2508-2524. [PMID: 37491460 PMCID: PMC10611575 DOI: 10.1038/s41380-023-02109-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality. RESULTS Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. CONCLUSION Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.
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Affiliation(s)
- Taís Boeira Biazus
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Schizophrenia Research Program (Projesq), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tokeshi
- Consultation Liaison, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luísa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 58185, Linköping, Sweden
| | - André F Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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Abstract
Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world's population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan. Early diagnosis is challenging and misdiagnoses are frequent, potentially resulting in missed early intervention and increasing the risk of iatrogenic harm. Over 15 approved treatments exist for the various phases of bipolar disorder, but outcomes are often suboptimal owing to insufficient efficacy, side effects, or lack of availability. Lithium, the first approved treatment for bipolar disorder, continues to be the most effective drug overall, although full remission is only seen in a subset of patients. Newer atypical antipsychotics are increasingly being found to be effective in the treatment of bipolar depression; however, their long term tolerability and safety are uncertain. For many with bipolar disorder, combination therapy and adjunctive psychotherapy might be necessary to treat symptoms across different phases of illness. Several classes of medications exist for treating bipolar disorder but predicting which medication is likely to be most effective or tolerable is not yet possible. As pathophysiological insights into the causes of bipolar disorders are revealed, a new era of targeted treatments aimed at causal mechanisms, be they pharmacological or psychosocial, will hopefully be developed. For the time being, however, clinical judgment, shared decision making, and empirical follow-up remain essential elements of clinical care. This review provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities available to treat people with bipolar disorder, highlighting recent advances and ongoing therapeutic challenges.
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Affiliation(s)
- Fernando S Goes
- Precision Medicine Center of Excellence in Mood Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:197-208. [PMID: 37201149 PMCID: PMC10172559 DOI: 10.1176/appi.focus.23021006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. Methods A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. Results In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Daniel Trujillo Diaz
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Zachary W Rupp
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Anubhav Kidambi
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Victor J Avila-Quintero
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Mark Olfson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Ramirez, Flores, Rhee, Bloch); Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA (Wilkinson, Bloch); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA (Diaz, Kidambi, Ramirez, Avila-Quintero, Bloch); Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA (Rupp); Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA (Olfson)
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11
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McIntyre RS, Alda M, Baldessarini RJ, Bauer M, Berk M, Correll CU, Fagiolini A, Fountoulakis K, Frye MA, Grunze H, Kessing LV, Miklowitz DJ, Parker G, Post RM, Swann AC, Suppes T, Vieta E, Young A, Maj M. The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management. World Psychiatry 2022; 21:364-387. [PMID: 36073706 PMCID: PMC9453915 DOI: 10.1002/wps.20997] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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Affiliation(s)
- Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- National Institute of Mental Health, Klecany, Czech Republic
| | - Ross J Baldessarini
- Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Mailman Research Center, McLean Hospital, Belmont, MA, USA
| | - Michael Bauer
- University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
- Orygen, National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena, Siena, Italy
| | - Kostas Fountoulakis
- 3rd Department of Psychiatry, Division of Neurosciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
| | - Heinz Grunze
- Allgemeinpsychiatrie Ost, Klinikum am Weissenhof, Weinsberg, Germany
- Paracelsus Medical Private University Nuremberg, Nuremberg, Germany
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles (UCLA) Semel Institute, Los Angeles, CA, USA
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Robert M Post
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- Bipolar Collaborative Network, Bethesda, MD, USA
| | - Alan C Swann
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Trisha Suppes
- Department of Psychiatry and Behavioural Sciences, Stanford School of Medicine and VA Palo Alto Health Care -System, Palo Alto, CA, USA
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Allan Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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12
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Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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13
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Sobanski T, Peikert G, Kastner UW, Wagner G. Suicidal behavior-advances in clinical and neurobiological research and improvement of prevention strategies. World J Psychiatry 2022; 12:1115-1126. [PMID: 36186502 PMCID: PMC9521537 DOI: 10.5498/wjp.v12.i9.1115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/26/2022] [Accepted: 08/18/2022] [Indexed: 02/05/2023] Open
Abstract
Suicide is the 14th leading cause of death worldwide. It is responsible for 1%-5% of all mortality. This article highlights the latest developments in universal, selective, and indicated prevention strategies. Concerning universal suicide prevention, current research has shown that strategies such as restricting access to lethal means (e.g., control of analgesics and hot-spots for suicide by jumping) and school-based awareness programs are most efficacious. Regarding selective prevention, substantial progress can be expected in psychological screening methods for suicidal behavior. The measurement of implicit cognition proved to be more valid in predicting future suicide attempts than classic clinical assessment. Latest developments are smartphone-based interventions and real-time monitoring of suicidal behavior. Great effort has been made to establish valid neurobiological screening methods (e.g., genetic and epigenetic risk factors for suicide, hypothalamic-pituitary-adrenal axis) without yielding a major bre-akthrough. Potentially, multiple biomarkers rather than a single one are necessary to identify individuals at risk. With regard to indicated prevention in form of psychopharmacological treatment, recent pharmacoepidemiological studies and meta-analyses have supported a protective role of antidepressants, lithium, and clozapine. However, the data concerning a specific anti-suicidal effect of these drugs are currently not consistent. Promising results exist for ketamine in reducing suicidal ideation, independently of its antidepressant effect. Concerning psychotherapy, recent findings suggest that psychotherapeutic interventions specifically designed to prevent suicide re-attempts are most efficacious. Specifically, cognitive behavioral therapy and psychodynamic therapy approaches proved to decrease the number of suicide re-attempts significantly.
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Affiliation(s)
- Thomas Sobanski
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, THUERINGEN-Kliniken GmbH, Saalfeld 07318, Germany
- Network for Suicide Prevention in Thuringia (NeST), Jena 07743, Germany
| | - Gregor Peikert
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena 07743, Germany
| | - Ulrich W Kastner
- Network for Suicide Prevention in Thuringia (NeST), Jena 07743, Germany
- Department of Psychiatry and Psychotherapy, Helios Fachkliniken Hildburghausen, Hildburghausen 98646, Germany
| | - Gerd Wagner
- Network for Suicide Prevention in Thuringia (NeST), Jena 07743, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena 07743, Germany
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14
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Yang C, Duan Y, Lei L, Liu P, Zhang A, Li G, Sun N, Wang Y, Liu Z, Zhang K. Altered Cingulum Functioning in Major Depressive Disorder Patient With Suicide Attempts: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurosci 2022; 16:849158. [PMID: 35418833 PMCID: PMC8995705 DOI: 10.3389/fnins.2022.849158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Major depressive disorder (MDD) with suicide attempts (SA) poses a significant public health issue. This study aims to identify neurobiological markers for MDD with SA on resting-state brain functional magnetic resonance imaging (rs-fMRI). Methods Fifty-one unmedicated adult MDD participants, 27 with SA on the Beck Scale for Suicidal Ideation and 24 without SA, underwent rs-fMRI scanning. A group of 30 healthy controls (HC) matched for age, gender, and education-level with MDD were chosen. A whole brain analysis of regional homogeneity (ReHo) was performed on subjects to identify regions where brain activity was associated with SA. Multiple comparison analysis was performed for ReHo. Pearson’s correlation analysis was performed between HAMD-SA scores and ReHo. The statistical significance level was set at p < 0.05. Results We examined whether there were significant differences among the three groups in whole brain ReHo during resting state. Subjects with SA showed significant increase of ReHo in the right Cingulum Post in comparison with those without SA. Subjects with SA showed significant decrease of ReHo in the right Cingulate Gyrus/Precuneus in comparison with HC. The mean ReHo from the significant brain region was associated with HAMD-SA (item 3 of the HAMD) scores (r = 0.349, P = 0.012) but was not associated with HAMD-24 scores. Conclusion These results indicate that SA is associated with altered resting-state brain activity. The pattern of elevated activity in the cingulum functioning may be related to SA. Identifying cingulum activity associated with SA may help to elucidate its pathogenesis and etiology.
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Affiliation(s)
- Chunxia Yang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yajuan Duan
- The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Lei Lei
- The First Hospital, Shanxi Medical University, Taiyuan, China
| | - Penghong Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Aixia Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ning Sun
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Nursing College of Shanxi Medical University, Taiyuan, China
| | - Yikun Wang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Zhifen Liu,
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
- Kerang Zhang,
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15
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Smith EG, Austin KL, Kim HM, Miller DR, Sauer BC, Valenstein M. Suicide death over the first year of lithium versus valproate treatment in cohorts with and without bipolar disorder. J Psychiatr Res 2022; 147:349-356. [PMID: 35158303 DOI: 10.1016/j.jpsychires.2021.12.011] [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: 07/09/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
This study examined if lithium's association with suicide risk varies by diagnosis. We performed separate 1:1 high-dimensional propensity score (hdPS)-matching in US Veterans with and without bipolar disorder starting lithium or valproate. Among individuals with bipolar disorder, actively receiving lithium (compared to valproate) was not associated with suicide risk. However, in intent-to-treat analyses (following all individuals with bipolar disorder starting lithium or valproate for all 365 days, regardless of whether they stopped the medication), starting lithium was significantly associated with higher one-year risks of suicide (HR = 1.50, 95% CI: 1.05-2.15, p = 0.03). These intent-to-treat risks were attributable entirely to transiently elevated suicide risks observed among individuals no longer receiving lithium (significant at 180 days [HR = 6.10, CI: 1.37-27.3, p = 0.02] but not 365 days [HR = 2.05, CI: 0.88-4.79, p = 0.10]). Among individuals without bipolar disorder, depending on the analysis, actively receiving lithium was associated with nonsignificantly (HR = 0.43, CI: 0.15-1.20, p = 0.11) or significantly (HR = 0.28, CI: 0.08-0.98, p = 0.047) decreased one-year suicide risks. Study limitations included limited power, brief follow-up, and potential residual confounding. Residual confounding is suggested by the observation that more individuals diagnosed with suicidal ideation started lithium than valproate (with this difference being statistically significant for individuals with bipolar disorder, p = 0.0012). If it were possible to correct for this potential confounding, then the suicide-related risks associated with among individuals discontinuing lithium would be expected to be less, and the suicide-related benefits associated with actively receiving lithium (already statistically significant in some analyses among individuals without bipolar disorder) would be expected to increase. Further research is needed.
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Affiliation(s)
- Eric G Smith
- Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Karen L Austin
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, VA Ann Arbor Healthcare System, Ann Arbor, MA, USA; Department of Veterans Affairs, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MA, USA.
| | - Hyungjin Myra Kim
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, VA Ann Arbor Healthcare System, Ann Arbor, MA, USA; Department of Veterans Affairs, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MA, USA; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MA, USA.
| | - Donald R Miller
- Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA.
| | - Brian C Sauer
- Department of Veterans Affairs, George E. Wahlen Veterans Health Administration, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Marcia Valenstein
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, VA Ann Arbor Healthcare System, Ann Arbor, MA, USA; Department of Veterans Affairs, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MA, USA; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, USA.
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16
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Wilkinson ST, Trujillo Diaz D, Rupp ZW, Kidambi A, Ramirez KL, Flores JM, Avila-Quintero VJ, Rhee TG, Olfson M, Bloch MH. Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta-analysis. Depress Anxiety 2022; 39:100-112. [PMID: 34762330 DOI: 10.1002/da.23222] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. METHODS A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. RESULTS In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. CONCLUSION Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.
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Affiliation(s)
- Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Zachary W Rupp
- Family and Community Medicine, University of Kentucky College of Medicine, Hazard, Kentucky, USA
| | - Anubhav Kidambi
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karina L Ramirez
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - José M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - T Greg Rhee
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Michael H Bloch
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.,Interventional Psychiatric Service, Yale School of Medicine, New Haven, Connecticut, USA.,Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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17
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Liaugaudaite V, Raskauskiene N, Naginiene R, Mickuviene N, Sher L. Association between lithium levels in drinking water and suicide rates: Role of affective disorders. J Affect Disord 2022; 298:516-521. [PMID: 34800570 DOI: 10.1016/j.jad.2021.11.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/07/2021] [Accepted: 11/14/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The study aimed to assess the association between lithium levels in drinking water from public supplies and suicide rates in different municipalities of Lithuania in relation with incidence of affective disorders. METHODS 53 drinking water samples were analysed from the main public drinking water systems of the country's municipalities. Lithium levels were determined using the ion chromatography method. Information on all registered affective disorders across all age groups and gender within the 5-year period was obtained from the Department of Statistics, and was averaged across the investigation time period. For the statistical analysis, lithium levels were averaged per municipality and plotted against suicide standardized mortality rates per 100,000 populations, within the 5-year period. RESULTS We found that lithium levels in drinking water are positively associated with the incidence of affective disorders. Our findings suggest higher incidence rates of affective disorders in the municipalities with a lithium level in drinking water above median compared to those in the municipalities with a lithium level below median and with the same socio-demographic and psychiatric characteristics. Suicide mortality rates are inversely associated with lithium levels in drinking water only in municipalities with higher lithium levels (above median) and with a high rate of affective disorders. CONCLUSION Based on our study results and insights we generate the following hypothesis for the further research, that lithium level in drinking water might have an important protective effect against suicide rates in the population with affective disorders.
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Affiliation(s)
- Vilma Liaugaudaite
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Nijole Raskauskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Rima Naginiene
- Laboratory of Toxicology, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Narseta Mickuviene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga, Lithuania
| | - Leo Sher
- James J. Peters Veterans, Administration Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, NY, United States
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18
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Proteins associated with future suicide attempts in bipolar disorder: A large-scale biomarker discovery study. Mol Psychiatry 2022; 27:3857-3863. [PMID: 35697758 PMCID: PMC9708594 DOI: 10.1038/s41380-022-01648-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 02/08/2023]
Abstract
Suicide is a major cause of death worldwide. Several biological systems have been implicated in suicidal behavior but studies of candidate biomarkers have failed to produce clinically relevant biomarkers for suicide prediction. The objective of the present study was to identify novel candidate biomarkers for suicidal behavior. We used a nested case-control study design where a large cohort of patients with bipolar disorder (N = 5 110) were followed up to 8 years after blood sampling. We included patients that attempted suicide during follow-up (N = 348) and matched bipolar disorder patients from the same cohort who did not attempt suicide during the study period (N = 348) and analyzed a total of 92 proteins with a neuro exploratory multiplex panel. Using a multivariate classification algorithm devised to minimize bias in variable selection, we identified a parsimonious set of proteins that best discriminated bipolar disorder patients with and without prospective suicide attempts. The algorithm selected 16 proteins for the minimal-optimal classification model, which outperformed 500 models with permuted outcome (p = 0.0004) but had low sensitivity (53%) and specificity (64%). The candidate proteins were then entered in separate logistic regression models to calculate protein-specific associations with prospective suicide attempts. In individual analyses, three of these proteins were significantly associated with prospective suicide attempt (SCGB1A1, ANXA10, and CETN2). Most of the candidate proteins are novel to suicide research.
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19
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Zhu H, Yao J, Fan H, Wang Q, Wang X, Gao Q. Prevalence and risk factors of suicidal ideation in adult inpatients with five different types of mental disorders. J Affect Disord 2021; 291:344-351. [PMID: 34087630 DOI: 10.1016/j.jad.2021.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/13/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Suicide is a major but preventable public health problem in the world. Mental disorders are related to suicide, and can predict suicidal ideation (SI). This study aims to compare the differences in the prevalence and risk factors of SI among patients with five types of mental disorders. METHODS This study involved adult inpatients with five types of mental disorders in Beijing Anding Hospital. Text mining was used to extract information from the electronic medical records. We performed the Pearson's Chi-square analysis and multivariable unconditional logistic regression to filter factors to assess odds of SI for each type of mental disorders. RESULTS Of the 21,287 participants included, 2,619 had experienced SI. For both sexes, the highest risk of SI was found for patients with recurrent depressive disorder (OR = 7.096; P <.001), followed by patients with depressive episode and bipolar affective disorder when comparing with those with substance use disorder. Gender, age, occupation, drinking, single child, personal relationship, family history of mental disorder, family history of suicide and psychological trauma were associated with SI after adjusting for confounding factors, but the risk factors and their effects in each type were different. LIMITATIONS The clear causal associations between mental disorders and SI cannot be elucidated. In addition, the ability to study the predictors of SI is constrained by the fact that the sample excluded people who completed suicide. CONCLUSIONS SI is common and distinct strategies should be taken in suicide prevention for patients with different types of mental disorders.
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Affiliation(s)
- Huiping Zhu
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing 100069, China
| | - Jiangyue Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing 100069, China
| | - Hua Fan
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Qian Wang
- Capital Medical University Affiliated Beijing Anding Hospital, Beijing, China
| | - Xiangran Wang
- Zhongshan Securities Company Limited, Shenzhen, China
| | - Qi Gao
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, 10 Xitoutiao, Youanmen Wai, Beijing 100069, China.
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20
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Tse AC, Fok ML, Yim LC, Leung MM, Leung CM. Diagnostic conversion to bipolar disorder in unipolar depressed patients in Hong Kong: A 20-year follow-up study. J Affect Disord 2021; 286:94-98. [PMID: 33714176 DOI: 10.1016/j.jad.2021.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/03/2021] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Bipolar (BP) disorder, especially BP depression is common and yet remains enigmatic until the emergence of mania. The rates and risk factors of conversion from unipolar (UP) depression to BP disorder reported vary. OBJECTIVE To study the long-term conversion rate from UP depression to BP disorder of an inpatient sample and identify the associated risk factors. METHODS This is a retrospective longitudinal study conducted in 2017 based on review of medical records of patients admitted to a regional hospital in Hong Kong with diagnosis of major depressive disorder during the period from 1988 to 2000. RESULTS A total of 19.5% of subjects had diagnostic shift from UP depression to BP disorder at follow-up, with a mean conversion time of 10.8 years and about 1% shift annually in the first 10 years. Risk factors include family history of mental illness, young age at onset, repeated admissions, psychotic symptoms and use of electroconvulsive therapy. More unconverted UP subjects (9.0%) committed suicide than those converted to BP (3.5%). LIMITATIONS The study is limited by its retrospective design. CONCLUSIONS Conversion from UP depression to BP disorder is dictated by its biological characteristics and clinical severity. Vigilance should be held in the first decade after onset when most conversion takes place.
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Affiliation(s)
- Ansen C Tse
- Department of Psychiatry, Shatin Hospital, Hong Kong
| | - Marcella Ly Fok
- Central and North West London NHS Foundation Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Larina Cl Yim
- Department of Psychiatry, Shatin Hospital, Hong Kong
| | - Meranda Mw Leung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Chi-Ming Leung
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong.
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21
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Tondo L, Vázquez GH, Baldessarini RJ. Prevention of suicidal behavior in bipolar disorder. Bipolar Disord 2021; 23:14-23. [PMID: 33037692 DOI: 10.1111/bdi.13017] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Excess mortality is a critical hallmark of bipolar disorder (BD) due to co-occurring general medical disorders and especially from suicide. It is timely to review of the status of suicide in BD and to consider the possibility of limiting suicidal risk. METHODS We carried out a semi-systematic review of recent research reports pertaining to suicide in BD. FINDINGS Suicide risk in BD is greater than with most other psychiatric disorders. Suicide rates (per 100,000/year) are approximately 11 and 4 in the adult and juvenile general populations, but over 200 in adults, and 100 among juveniles diagnosed with BD. Suicide attempt rates with BD are at least 20 times higher than in the adult general population, and over 50 times higher among juveniles. Notable suicidal risk factors in BD include: previous suicidal acts, depression, mixed-agitated-dysphoric moods, rapid mood-shifts, impulsivity, and co-occurring substance abuse. Suicide-preventing therapeutics for BD remain severely underdeveloped. Evidence favoring lithium treatment is stronger than for other measures, although encouraging findings are emerging for other treatments. CONCLUSIONS Suicide is a leading clinical challenge for those caring for BD patients. Improved understanding of risk and protective factors combined with knowledge and close follow-up of BD patients should limit suicidal risk. Ethically appropriate and scientifically sound studies of plausible medicinal, physical, and psychosocial treatments aimed at suicide prevention specifically for BD patients are urgently needed.
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Affiliation(s)
- Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
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22
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Source-based morphometry reveals gray matter differences related to suicidal behavior in criminal offenders. Brain Imaging Behav 2020; 14:1-9. [PMID: 30215220 DOI: 10.1007/s11682-018-9957-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Relative to the general population, criminal offenders have a higher risk of suicide. Neurobiological deficits related to suicidal behavior have been identified in the general population, but unexamined in offenders to date. We examined the association between brain morphology and suicidal behavior in adult male criminal offenders. Brain morphology was examined using voxel-based morphometry (VBM) and source-based morphometry (SBM), a multivariate alternative to VBM which analyzes brain volume in between-subject spatially independent networks. Results showed that offenders with past suicide attempts (n = 19), relative to offenders without past suicide attempts (n = 19) and non-offenders (n = 26), had reduced gray matter in an SBM component that comprised the posterior cingulate, dorsal prefrontal cortex, and amygdala. The SBM source weights were significantly associated with suicide attempts independent of other suicide risk variables (e.g., depression). VBM results were similar to the SBM results but less robust. The results reveal a potential neurobiological marker of vulnerability to suicidal behavior among criminal offenders and illustrate the utility of multivariate methods of gray matter analyses.
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23
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Bertrand L, Bourguignon C, Beaulieu S, Storch KF, Linnaranta O. Suicidal Ideation and Insomnia in Bipolar Disorders: Idéation suicidaire et insomnie dans les troubles bipolaires. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:802-810. [PMID: 32856463 PMCID: PMC7564692 DOI: 10.1177/0706743720952226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar disorder (BD) confers elevated suicide risk and associates with misaligned circadian rhythm. Real-time monitoring of objectively measured sleep is a novel approach to detect and prevent suicidal behavior. We aimed at understanding associations between subjective insomnia and actigraphy data with severity of suicidal ideation in BDs. METHODS This prospective cohort study comprised 76 outpatients with a BD aged 18 to 65 inclusively. Main measures included 10 consecutive days of wrist actigraphy; the Athens Insomnia Scale (AIS); the Montgomery-Åsberg Depression Rating Scale (MADRS); the Quick Inventory of Depressive Symptoms-16, self-rating (QIDS-SR-16); and the Columbia Suicide Severity Rating Scale. Diagnoses, medications, and suicide attempts were obtained from chart review. RESULTS Suicidal ideation correlated moderately with subjective insomnia (AIS with QIDS-SR-16 item 12 ρ =0.26, P = 0.03; MADRS item 10 ρ = 0.33, P = 0.003). Graphical sleep patterns showed that suicidal patients were enriched among the most fragmented sleep patterns, and this was confirmed by correlations of suicidal ideation with actigraphy data at 2 visits. Patients with lifetime suicide attempts (n = 8) had more varied objective sleep (a higher standard deviation of center of daily inactivity [0.64 vs. 0.26, P = 0.01], consolidation of daily inactivity [0.18 vs. 0.10, P = <0.001], sleep offset [3.02 hours vs. 1.90 hours, P = <0.001], and total sleep [105 vs. 69 minutes, P = 0.02], and a lower consolidation of daily inactivity [0.65 vs. 0.79, P = 0.03]). CONCLUSIONS Subjective insomnia, a nonstigmatized symptom, can complement suicidality screens. Longer follow-ups and larger samples are warranted to understand whether real-time sleep monitoring predicts suicidal ideation in patient subgroups or individually.
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Affiliation(s)
- Lia Bertrand
- Faculty of Medicine, 5620McGill University, Montreal, Quebec, Canada
| | - Clément Bourguignon
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Integrated Program in Neuroscience, 5620McGill University, Montreal, Quebec, Canada
| | - Serge Beaulieu
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
| | - Kai-Florian Storch
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada
| | - Outi Linnaranta
- Douglas Centre for Sleep and Biological Rhythms, 26632Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, 5620McGill University, Montreal, Quebec, Canada.,National Institute for Health and Welfare, Helsinki, Finland
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24
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Del Matto L, Muscas M, Murru A, Verdolini N, Anmella G, Fico G, Corponi F, Carvalho A, Samalin L, Carpiniello B, Fagiolini A, Vieta E, Pacchiarotti I. Lithium and suicide prevention in mood disorders and in the general population: A systematic review. Neurosci Biobehav Rev 2020; 116:142-153. [DOI: 10.1016/j.neubiorev.2020.06.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/06/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
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25
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Baldessarini RJ, Tondo L. Suicidal Risks in 12 DSM-5 Psychiatric Disorders. J Affect Disord 2020; 271:66-73. [PMID: 32312699 DOI: 10.1016/j.jad.2020.03.083] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/22/2020] [Accepted: 03/24/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE As modern studies evaluating suicidal behaviors in large samples of major psychiatric disorder patients are rare, we compared suicidal risks associated with a variety of psychiatric diagnoses. METHODS We quantified rates of intake suicidal ideation and lifetime attempts, suicides, and violent acts (attempts + suicides) in 6050 adult patients in a European psychiatric center, diagnosed with 12 prevalent, DSM-5 psychiatric disorders. RESULTS Ideation ranged from 53.9% of subjects with bipolar disorder (BD) with mixed features, to 8.70% in anxiety disorders. Subjects making at least one suicide attempt were most prevalent in BD with mixed or psychotic features. Suicide rates ranked: substance abuse > BD with psychotic features > psychotic disorders ≥ BD-I > major depressive disorder (MDD). Suicidal intensity (acts/100 PEY) was highest with BD, psychotic disorders, and MDD; lethality (lower attempt/suicide ratio) was greatest with substance abuse, psychotic disorders, and BD with psychotic features. Rates of suicidal acts in BD vs. MDD were similarly high among ever-hospitalized subjects but much lower in never-hospitalized MDD subjects. Women had higher overall risks of ideation and attempts, but violent acts and suicide were more likely among men, whereas SMR for suicide was greater among women, presumably reflecting very low risks among women in the regional general population. CONCLUSIONS Suicidal risks were particularly high in BD with psychotic or mixed features as well as with substance abuse and in severe MDD with hospitalization.
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Affiliation(s)
- R J Baldessarini
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
| | - L Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA; Lucio Bini Mood Disorders Centers, Cagliari and Rome, Italy
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26
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Malhi GS, Das P, Outhred T, Bryant RA, Calhoun V, Mann JJ. Default mode dysfunction underpins suicidal activity in mood disorders. Psychol Med 2020; 50:1214-1223. [PMID: 31144614 DOI: 10.1017/s0033291719001132] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Suicide is a serious and not uncommon consequence of mood disorders that occurs primarily when individuals are depressed. Understanding the neurobiology of suicidal activity (thoughts or behaviors) is likely to facilitate prevention. METHOD Seventy-nine adult depressed mood disorder patients (MDP), of which 25 had attempted suicide at least once, and 66 healthy controls (HC) participated in this study. Resting-state functional MRI was used to identify neural activity differences between suicide attempters (SA) and non-attempters (NA). Specifically, differences were examined in functional connectivity both within and between four large cognitive networks [Executive Control (ECN), Default Mode (DMN), Salience (SN), and Basal Ganglia (BGN)] and their respective associations with suicidal activity. RESULTS Compared to HCs, patients had greater posterior DMN activity, but less activity in the BGN, and less low-frequency spectral power in the dorso-medial DMN. Furthermore, increased posterior DMN activity in SA was associated with recent suicidal activity, whereas NA had reduced BGN activity and less dorso-medial DMN spectral power, the latter being associated with lifelong suicidal thinking. SA also had greater activity in midline circuitry compared to both HC and NA, and the pattern of BGN and DMN co-activity differed between SA and NA. CONCLUSIONS DMN engagement raises the possibility that suicidal activity in mood disorder patients may be a consequence of impaired self-referential thought processing. Furthermore, differential BGN and DMN co-activation according to suicide attempt status suggests that attempting suicide perhaps alters cognitive flexibility. These insights are potentially useful for understanding the neural basis of suicide activity.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW2065, Australia
- ARCHI, Sydney Medical School Northern, The University of Sydney, NSW2006, Australia
- Sydney Medical School Northern, The University of Sydney, NSW2006, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW2065, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW2065, Australia
- ARCHI, Sydney Medical School Northern, The University of Sydney, NSW2006, Australia
- Sydney Medical School Northern, The University of Sydney, NSW2006, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW2065, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW2065, Australia
- ARCHI, Sydney Medical School Northern, The University of Sydney, NSW2006, Australia
- Sydney Medical School Northern, The University of Sydney, NSW2006, Australia
- CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW2065, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, NSW2052, Australia
| | - Vince Calhoun
- The Mind Research Network, Albuquerque, NM, USA
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, USA
- Molecular Imaging and the Neuropathology Division, New York State Psychiatric Institute, New York, USA
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27
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Möller HJ, Bitter I, Bobes J, Fountoulakis K, Höschl C, Kasper S. Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression. Eur Psychiatry 2020; 27:114-28. [DOI: 10.1016/j.eurpsy.2011.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/28/2022] Open
Abstract
AbstractThis position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy. The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and four for maintenance treatment. Monotherapy with one drug is often not sufficient and has to be followed by other antidepressants or by comedication/augmentation therapy approaches. Generally, antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk–benefit relationship of treatment with antidepressants can be judged as favourable also in this respect. The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome. The ideal that all steps of clinical decision-making can be based on the strict rules of evidence-based medicine is far away from reality. Clinical experience so far still has a great impact.
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28
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Qiu H, Cao B, Cao J, Li X, Chen J, Wang W, Lv Z, Zhang S, Fang W, Ai M, Kuang L. Resting-state functional connectivity of the anterior cingulate cortex in young adults depressed patients with and without suicidal behavior. Behav Brain Res 2020; 384:112544. [PMID: 32035184 DOI: 10.1016/j.bbr.2020.112544] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/19/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
Abstract
Functional alterations in the subregions of the anterior cingulate cortex (ACC) have been observed in patients with major depressive disorder (MDD). Studies have shown that higher depressive symptoms are associated with altered functional connectivity (FC) in different ACC sub-regions. Suicide is highly prevalent in patients with MDD; however, it is unclear whether suicidal behavior is associated with the FC alterations in the subregions of the ACC in these indibiduals. Seventy-six patients with MDD (41 with and 35 without a history of suicidal behavior) underwent functional magnetic resonance imaging (fMRI) and were assessed using the Hamilton Rating Scale for Depression (HAMD), the Scale for Suicide Ideation (SSI), and the Columbia Scale for Rating of Suicide Severity. We investigated the FC between the ACC subregions and other brain regions in young MDD patients with and without a history of suicidal behavior. The FC in the subregions of the ACC-superior frontal gyrus differed significantly between the two groups. Additionally, the anterior sgACC-right caudate FC and the pgACC-left insula FC were found to be abnormal in the suicidal MDD group. Interestingly, the suicidal ideation score positively correlated with decreased FC in the pgACC-superior frontal gyrus in both groups, but it negatively correlated with increased FC in the anterior sgACC-superior frontal gyrus in the non-suicidal MDD group. Our findings indicate that altered connections of subregions in the ACC may be involved in the neurological mechanisms underlying suicide in young adults with MDD.
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Affiliation(s)
- Haitang Qiu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Bo Cao
- Department of Psychiatry, University of Alberta, Edmonton Alberta, Canada
| | - Jun Cao
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Xinke Li
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing 400044, PR China
| | - Jianmei Chen
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Wo Wang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Zhen Lv
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Shuang Zhang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Weidong Fang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Ming Ai
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China.
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China.
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29
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Grundsøe TL, Pedersen ML. Risk factors observed in health care system 6 months prior completed suicide. Int J Circumpolar Health 2020; 78:1617019. [PMID: 31084408 PMCID: PMC6522904 DOI: 10.1080/22423982.2019.1617019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Ten percent of all deaths in Greenland are caused by suicide. The aim of this study was to explore if applicable risk factors could be identified among the suicide victims within the health care system up to 6 months prior to the suicide. The study was performed as an age- and gender-matched case control study including all suicides in Greenland from 2012 to 2015, based on review of medical records for risk factors including suicide ideation, suicide attempts, incidence of alcohol intoxication, incidence of violence and treatment for psychiatric illness within the 6 month period leading up to the suicide. In total, 160 cases and 160 controls were included. Presence of any risk factors were observed in around a third of all suicide cases compared a tenth among the controls. The highest odds ratios for suicide were observed for suicide ideation and suicide attempts. However, no contact with the health care system was observed for two thirds of the suicides victims. Thus, focus on suicide ideation and suicide attempts among patients could help health care professionals to assess suicide risk and initiate prevention. Additional preventive strategies targeting the majority without contact to the health care system need to be explored.
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Affiliation(s)
| | - Michael Lynge Pedersen
- a Queen Ingrid Health Care Center , Nuuk , Greenland.,b Greenland Center of Health Research, Institute of Nursing and Health Science , University of Greenland , Nuuk , Greenland
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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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Baldessarini RJ, Vázquez GH, Tondo L. Bipolar depression: a major unsolved challenge. Int J Bipolar Disord 2020; 8:1. [PMID: 31903509 PMCID: PMC6943098 DOI: 10.1186/s40345-019-0160-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/27/2019] [Indexed: 12/16/2022] Open
Abstract
Depression in bipolar disorder (BD) patients presents major clinical challenges. As the predominant psychopathology even in treated BD, depression is associated not only with excess morbidity, but also mortality from co-occurring general-medical disorders and high suicide risk. In BD, risks for medical disorders including diabetes or metabolic syndrome, and cardiovascular disorders, and associated mortality rates are several-times above those for the general population or with other psychiatric disorders. The SMR for suicide with BD reaches 20-times above general-population rates, and exceeds rates with other major psychiatric disorders. In BD, suicide is strongly associated with mixed (agitated-dysphoric) and depressive phases, time depressed, and hospitalization. Lithium may reduce suicide risk in BD; clozapine and ketamine require further testing. Treatment of bipolar depression is far less well investigated than unipolar depression, particularly for long-term prophylaxis. Short-term efficacy of antidepressants for bipolar depression remains controversial and they risk clinical worsening, especially in mixed states and with rapid-cycling. Evidence of efficacy of lithium and anticonvulsants for bipolar depression is very limited; lamotrigine has long-term benefit, but valproate and carbamazepine are inadequately tested and carry high teratogenic risks. Evidence is emerging of short-term efficacy of several modern antipsychotics (including cariprazine, lurasidone, olanzapine-fluoxetine, and quetiapine) for bipolar depression, including with mixed features, though they risk adverse metabolic and neurological effects.
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Affiliation(s)
- Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
| | - Gustavo H Vázquez
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada
| | - Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Bipolar & Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Center, Cagliari, Sardinia, Italy
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Li K, Liao Y, Yang Z, Yang C, Chen M, Wu X, Gan Z. Case Report: Paliperidone Palmitate in the Management of Bipolar I Disorder With Non-compliance. Front Psychiatry 2020; 11:529672. [PMID: 33488408 PMCID: PMC7819884 DOI: 10.3389/fpsyt.2020.529672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Medication non-adherence is prevalent in patients with bipolar disorder (BD). Long-acting injectable antipsychotics (LAIAs) are widely used to improve compliance with treatment. This study aimed to illustrate the effectiveness, compliance, and safety profile of once-monthly paliperidone palmitate (PP1M), a novel therapeutic LAIA, in the management of bipolar I disorder (BDI). Method: A prospective follow-up was arranged to 11 BDI patients who were prescribed PP1M as monotherapy or adjunctive treatment. Severity of symptoms, disturbing behavior, status of employment, 17-item Hamilton Depression Rating Scale (HAMD-17), and Young Mania Rating Scale (YMRS) were evaluated at the baseline and the endpoint of follow-up. Clinical Global Impression-Bipolar Disorder-Severity of Illness Scale (CGI-BP) and Treatment Emergent Symptom Scale (TESS) were measured at each injection of PP1M. Compliance, relapse or switch, and new hospitalization were monitored through the period of follow-up. Results: The median duration of treatment was 14 months, ranging from 5 to 22 months. The scores (mean ± standard deviation) of HAMD-17, YMRS, and CGI-BP generally decreased from the baseline (16.1 ± 10.3, 30.9 ± 12.6, 5.3 ± 0.7) to the endpoint (7.4 ± 5.7, 3.7 ± 3.2, 2.3 ± 0.7). No disturbing behavior was detected at the endpoint. Neither new hospitalization nor manic/mixed episode occurred during treatment, whereas mild to moderate depressive episodes were reported in three cases. The status of employment of 10 participants (90.9%) was improved, and no new safety concern was detected. Conclusion: PP1M might offer a new valid treatment option in the long-term management of BDI, especially for those with poor compliance with oral medication. However, more studies are needed to further justify such role.
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Affiliation(s)
- Kanglai Li
- Very Important Patients Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingtao Liao
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhihua Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Caishuang Yang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Minhua Chen
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiuhua Wu
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhaoyu Gan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Söderholm JJ, Socada JL, Rosenström T, Ekelund J, Isometsä ET. Borderline Personality Disorder With Depression Confers Significant Risk of Suicidal Behavior in Mood Disorder Patients-A Comparative Study. Front Psychiatry 2020; 11:290. [PMID: 32362847 PMCID: PMC7181053 DOI: 10.3389/fpsyt.2020.00290] [Citation(s) in RCA: 20] [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: 09/06/2019] [Accepted: 03/24/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE We investigated risk factors for suicidal ideation and behavior among currently depressed patients with major depressive disorder (MDD), major depressive episode (MDE) in bipolar disorder (BD), or MDE with comorbid borderline personality disorder (MDE/BPD). We compared current and lifetime prevalence of suicidal ideation and behavior, and investigated dimensional measures of BPD or mixed affective features of the MDE as indicators of risk. METHODS Based on screening of 1,655 referrals, we recruited 124 psychiatric secondary care outpatients with MDE and stratified them into three subcohorts (MDD, BD, and MDE/BPD) using the Structured Clinical Interview for DSM-IV I and II. We examined suicidal ideation and behavior with the Columbia Suicide Severity Rating Scale (CSSRS). In addition, we quantified the severity of BPD symptoms and BD mixed features both categorically/diagnostically and dimensionally (using instruments such as the Borderline Personality Disorder Severity Index) in two time frames. RESULTS There were highly significant differences between the lifetime prevalences of suicide attempts between the subcohorts, with attempts reported by 16% of the MDD, 30% of the BD, and 60% of the BPD subcohort. Remarkably, the lifetime prevalence of suicide attempts in patients with comorbid BD and BPD exceeded 90%. The severity of BPD features was independently associated with risk of suicide attempts both lifetime and during the current MDE. It also associated in a dose-dependent manner with recent severity of ideation in both BPD and non-BPD patients. In multinominal logistic regression models, hopelessness was the most consistent independent risk factor for severe suicidal ideation in both time frames, whereas younger age and more severe BPD features were most consistently associated with suicide attempts. CONCLUSIONS Among patients with major depressive episodes, diagnosis of bipolar disorder, or presence of comorbid borderline personality features both imply remarkably high risk of suicide attempts. Risk factors for suicidal ideation and suicidal acts overlap, but may not be identical. The estimated severity of borderline personality features seems to associate with history of suicidal behavior and current severity of suicidal ideation in dose-dependent fashion among all mood disorder patients. Therefore, reliable assessment of borderline features may advance the evaluation of suicide risk.
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Affiliation(s)
- John J Söderholm
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - J Lumikukka Socada
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jesper Ekelund
- Department of Psyhiatry, University of Turku and Turku University Central Hospital, Turku, Finland
| | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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34
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Prevalence of suicide attempts in bipolar disorder: a systematic review and meta-analysis of observational studies. Epidemiol Psychiatr Sci 2019; 29:e63. [PMID: 31648654 PMCID: PMC8061290 DOI: 10.1017/s2045796019000593] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS Bipolar disorder (BD) is a severe psychiatric disorder associated with a high risk of suicide. This meta-analysis examined the prevalence of suicide attempts (SA) in patients with BD and its associated factors. METHODS A systematic literature search was conducted in the PubMed, PsycINFO, EMBASE and Web of Science databases from their inception to 11 June 2018. The prevalence of SA in BD was synthesised using the random-effects model. RESULTS The search identified 3451 articles of which 79 studies with 33 719 subjects met the study entry criteria. The lifetime prevalence of SA was 33.9% (95% CI 31.3-36.6%; I2 = 96.4%). Subgroup and meta-regression analyses revealed that the lifetime prevalence of SA was positively associated with female gender, BD-I, BD Not Otherwise Specified and rapid cycling BD subtypes, income level and geographic region. CONCLUSION This meta-analysis confirmed that SA is common in BD and identified a number of factors related to SA. Further efforts are necessary to facilitate the identification and prevention of SA in BD. Long-term use of mood stabilisers coupled with psycho-social interventions should be available to BD patients to reduce the risk of suicidal behaviour.
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Tondo L, Alda M, Bauer M, Bergink V, Grof P, Hajek T, Lewitka U, Licht RW, Manchia M, Müller-Oerlinghausen B, Nielsen RE, Selo M, Simhandl C, Baldessarini RJ. Clinical use of lithium salts: guide for users and prescribers. Int J Bipolar Disord 2019; 7:16. [PMID: 31328245 PMCID: PMC6643006 DOI: 10.1186/s40345-019-0151-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/27/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lithium has been used clinically for 70 years, mainly to treat bipolar disorder. Competing treatments and exaggerated impressions about complexity and risks of lithium treatment have led to its declining use in some countries, encouraging this update about its safe clinical use. We conducted a nonsystematic review of recent research reports and developed consensus among international experts on the use of lithium to treat major mood disorders, aiming for a simple but authoritative guide for patients and prescribers. MAIN TEXT We summarized recommendations concerning safe clinical use of lithium salts to treat major mood disorders, including indications, dosing, clinical monitoring, adverse effects and use in specific circumstances including during pregnancy and for the elderly. CONCLUSIONS Lithium continues as the standard and most extensively evaluated treatment for bipolar disorder, especially for long-term prophylaxis.
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Affiliation(s)
- Leonardo Tondo
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA. .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Lucio Bini Mood Disorders Centers, Lucio Bini Center, Via Cavalcanti 28, 09128, Cagliari and Rome, Italy.
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, Dresden, Germany
| | - Veerle Bergink
- Department of Psychiatry and Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, USA.,Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Paul Grof
- Mood Disorders Center of Ottawa and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ute Lewitka
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital Dresden, Dresden, Germany
| | - Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Aalborg University Hospital-Psychiatry, Aalborg, Denmark
| | - Mirko Manchia
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - René E Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Aalborg University Hospital-Psychiatry, Aalborg, Denmark
| | | | - Christian Simhandl
- Medical Faculty, Bipolar Center, Sigmund Freud Private University, Wiener Neustadt, Austria
| | - Ross J Baldessarini
- International Consortium for Research on Mood & Psychotic Disorders, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Melhem NM, Porta G, Oquendo MA, Zelazny J, Keilp JG, Iyengar S, Burke A, Birmaher B, Stanley B, Mann JJ, Brent DA. Severity and Variability of Depression Symptoms Predicting Suicide Attempt in High-Risk Individuals. JAMA Psychiatry 2019; 76:603-613. [PMID: 30810713 PMCID: PMC6551844 DOI: 10.1001/jamapsychiatry.2018.4513] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Predicting suicidal behavior continues to be among the most challenging tasks in psychiatry. OBJECTIVES To examine the trajectories of clinical predictors of suicide attempt (specifically, depression symptoms, hopelessness, impulsivity, aggression, impulsive aggression, and irritability) for their ability to predict suicide attempt and to compute a risk score for suicide attempts. DESIGN, SETTING, AND PARTICIPANTS This is a longitudinal study of the offspring of parents (or probands) with mood disorders who were recruited from inpatient units at Western Psychiatric Institute and Clinic (Pittsburgh) and New York State Psychiatric Institute. Participants were recruited from July 15, 1997, to September 6, 2005, and were followed up through January 21, 2014. Probands and offspring (n = 663) were interviewed at baseline and at yearly follow-ups for 12 years. Lifetime and current psychiatric disorders were assessed, and self-reported questionnaires were administered. Model evaluation used 10-fold cross-validation, which split the entire data set into 10 equal parts, fit the model to 90% of the data (training set), and assessed it on the remaining 10% (test set) and repeated that process 10 times. Preliminary analyses were performed from July 20, 2015, to October 5, 2016. Additional analyses were conducted from July 26, 2017, to July 24, 2018. MAIN OUTCOMES AND MEASURES The broad definition of suicide attempt included actual, interrupted, and aborted attempts as well as suicidal ideation that prompted emergency referrals during the study. The narrow definition referred to actual attempt only. RESULTS The sample of offspring (n = 663) was almost equally distributed by sex (316 female [47.7%]) and had a mean (SD) age of 23.8 (8.5) years at the time of censored observations. Among the 663 offspring, 71 (10.7%) had suicide attempts over the course of the study. The trajectory of depression symptoms with the highest mean scores and variability over time was the only trajectory to predict suicide attempt (odds ratio [OR], 4.72; 95% CI, 1.47-15.21; P = .01). In addition, we identified the following predictors: younger age (OR, 0.82; 95% CI, 0.74-0.90; P < .001), lifetime history of unipolar disorder (OR, 4.71; 95% CI, 1.63-13.58; P = .004), lifetime history of bipolar disorder (OR, 3.4; 95% CI, 0.96-12.04; P = .06), history of childhood abuse (OR, 2.98; 95% CI, 1.40-6.38; P = .01), and proband actual attempt (OR, 2.24; 95% CI, 1.06-4.75; P = .04). Endorsing a score of 3 or higher on the risk score tool resulted in high sensitivity (87.3%) and moderate specificity (63%; area under the curve = 0.80). CONCLUSIONS AND RELEVANCE The specific predictors of suicide attempt identified are those that clinicians already assess during routine psychiatric evaluations; monitoring and treating depression symptoms to reduce their severity and fluctuation may attenuate the risk for suicidal behavior.
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Affiliation(s)
- Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Giovanna Porta
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maria A. Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jamie Zelazny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John G. Keilp
- Department of Psychiatry, Columbia University, New York, New York
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ainsley Burke
- Department of Psychiatry, Columbia University, New York, New York
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Barbara Stanley
- Department of Psychiatry, Columbia University, New York, New York
| | - J. John Mann
- Department of Psychiatry, Columbia University, New York, New York
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Beckwith N, McDowell MJ, Reisner SL, Zaslow S, Weiss RD, Mayer KH, Keuroghlian AS. Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center. LGBT Health 2019; 6:51-61. [PMID: 30707624 PMCID: PMC6434596 DOI: 10.1089/lgbt.2018.0136] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. METHODS We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. RESULTS Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98). CONCLUSION Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.
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Affiliation(s)
- Noor Beckwith
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Michal J. McDowell
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sari L. Reisner
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shayne Zaslow
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Sociology, University of Virginia, Charlottesville, Virginia
| | - Roger D. Weiss
- Harvard Medical School, Boston, Massachusetts
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alex S. Keuroghlian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
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38
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Coryell W. Impact, Diagnosis, Phenomenology, and Biology. Handb Exp Pharmacol 2019; 250:3-33. [PMID: 31004226 DOI: 10.1007/164_2018_156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This section provides summaries of the epidemiology, phenomenology, nosology, and the suspected biological substrates of the depressive disorders. It particularly emphasizes the historical evolution of the pertinent diagnostic constructs and the prognostic import both of the various diagnostic groupings and of the individual symptoms and symptom clusters.
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Affiliation(s)
- William Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa Health Care, Iowa City, IA, USA.
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Plans L, Barrot C, Nieto E, Rios J, Schulze TG, Papiol S, Mitjans M, Vieta E, Benabarre A. Association between completed suicide and bipolar disorder: A systematic review of the literature. J Affect Disord 2019; 242:111-122. [PMID: 30173059 DOI: 10.1016/j.jad.2018.08.054] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Completed suicide is a major cause of death in bipolar disorder (BD) patients. OBJECTIVE The aim of this paper is to provide an overall review of the existing literature of completed suicide in BD patients, including clinical and genetic data DATA SOURCES: We performed a systematic review of English and non-English articles published on MEDLINE/PubMed, PsycInfo and Cochrane database (1970-2017). Additional studies were identified by contacting clinical experts, searching bibliographies, major textbooks and website of World Health Organization. Initially we did a broad search for the association of bipolar disorder and suicide and we were narrowing the search in terms included "bipolar disorder" and "completed suicide". STUDY SELECTION Inclusion criteria were articles about completed suicide in patients with BD. Articles exclusively focusing on suicide attempts and suicidal behaviour have been excluded. We used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) consensus for drafting this systematic review. RESULTS The initial search generated 2806 articles and a total of 61 meeting our inclusion criteria. We reviewed epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD. Suicide rates in BD vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population. The highest risk of successful suicide was observed in BD-II subjects. The heritability of completed suicide is about 40% and some genes related to major neurotransmitter systems have been associated with suicide. Lithium is the only treatment that has shown anti-suicide potential. LIMITATIONS The most important limitation of the present review is the limited existing literature on completed suicide in BD. CONCLUSIONS BD patients are at high risk for suicide. It is possible to identify some factors related to completed suicide, such as early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. However it is necessary to promote research on this serious health problem.
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Affiliation(s)
- L Plans
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - C Barrot
- Forensic Genetic Laboratori, University of Barcelona, Catalonia, Spain
| | - E Nieto
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - J Rios
- Universitat Autònoma de Barcelona, Laboratório de Bioestatística e Epidemiologia, Barcelona, Spain; Hospital Clínic, IDIBAPS, Bioestadística y Plataforma de Gestión de Datos, Barcelona, Spain
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Munich, Germany
| | - S Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - M Mitjans
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - E Vieta
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - A Benabarre
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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40
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Jawad I, Watson S, Haddad PM, Talbot PS, McAllister-Williams RH. Medication nonadherence in bipolar disorder: a narrative review. Ther Adv Psychopharmacol 2018; 8:349-363. [PMID: 30524703 PMCID: PMC6278745 DOI: 10.1177/2045125318804364] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/01/2018] [Indexed: 12/14/2022] Open
Abstract
A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.
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Affiliation(s)
- Ibrahim Jawad
- Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Stuart Watson
- Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Peter M Haddad
- Neuroscience and Psychiatry Unit, University of Manchester, Manchester, UK Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter S Talbot
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic, Health Science Centre, Manchester, UK
| | - R Hamish McAllister-Williams
- Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Northern Centre for Mood Disorders and Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
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Jones S, Riste L, Barrowclough C, Bartlett P, Clements C, Davies L, Holland F, Kapur N, Lobban F, Long R, Morriss R, Peters S, Roberts C, Camacho E, Gregg L, Ntais D. Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care – the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2018. [DOI: 10.3310/pgfar06060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundBipolar disorder (BD) costs £5.2B annually, largely as a result of incomplete recovery after inadequate treatment.ObjectivesA programme of linked studies to reduce relapse and suicide in BD.DesignThere were five workstreams (WSs): a pragmatic randomised controlled trial (RCT) of group psychoeducation (PEd) versus group peer support (PS) in the maintenance of BD (WS1); development and feasibility RCTs of integrated psychological therapy for anxiety in bipolar disorder (AIBD) and integrated for problematic alcohol use in BD (WS2 and WS3); survey and qualitative investigations of suicide and self-harm in BD (WS4); and survey and qualitative investigation of service users’ (SUs) and psychiatrists’ experience of the Mental Capacity Act 2005 (MCA), with reference to advance planning (WS5).SettingParticipants were from England; recruitment into RCTs was limited to certain sites [East Midlands and North West (WS1); North West (WS2 and WS3)].ParticipantsAged ≥ 18 years. In WS1–3, participants had their diagnosis of BD confirmed by the Structural Clinical Interview for theDiagnostic and Statistical Manual of Mental Disorders.InterventionsIn WS1, group PEd/PS; in WS3 and WS4, individual psychological therapy for comorbid anxiety and alcohol use, respectively.Main outcome measuresIn WS1, time to relapse of bipolar episode; in WS2 and WS3, feasibility and acceptability of interventions; in WS4, prevalence and determinants of suicide and self-harm; and in WS5, professional training and support of advance planning in MCA, and SU awareness and implementation.ResultsGroup PEd and PS could be routinely delivered in the NHS. The estimated median time to first bipolar relapse was 67.1 [95% confidence interval (CI) 37.3 to 90.9] weeks in PEd, compared with 48.0 (95% CI 30.6 to 65.9) weeks in PS. The adjusted hazard ratio was 0.83 (95% CI 0.62 to 1.11; likelihood ratio testp = 0.217). The interaction between the number of previous bipolar episodes (1–7 and 8–19, relative to 20+) and treatment arm was significant (χ2 = 6.80, degrees of freedom = 2;p = 0.034): PEd with one to seven episodes showed the greatest delay in time to episode. A primary economic analysis indicates that PEd is not cost-effective compared with PS. A sensitivity analysis suggests potential cost-effectiveness if decision-makers accept a cost of £37,500 per quality-adjusted life-year. AIBD and motivational interviewing (MI) cognitive–behavioural therapy (CBT) trials were feasible and acceptable in achieving recruitment and retention targets (AIBD:n = 72, 72% retention to follow-up; MI-CBT:n = 44, 75% retention) and in-depth qualitative interviews. There were no significant differences in clinical outcomes for either trial overall. The factors associated with risk of suicide and self-harm (longer duration of illness, large number of periods of inpatient care, and problems establishing diagnosis) could inform improved clinical care and specific interventions. Qualitative interviews suggested that suicide risk had been underestimated, that care needs to be more collaborative and that people need fast access to good-quality care. Despite SUs supporting advance planning and psychiatrists being trained in MCA, the use of MCA planning provisions was low, with confusion over informal and legally binding plans.LimitationsInferences for routine clinical practice from WS1 were limited by the absence of a ‘treatment as usual’ group.ConclusionThe programme has contributed significantly to understanding how to improve outcomes in BD. Group PEd is being implemented in the NHS influenced by SU support.Future workFuture work is needed to evaluate optimal approaches to psychological treatment of comorbidity in BD. In addition, work in improved risk detection in relation to suicide and self-harm in clinical services and improved training in MCA are indicated.Trial registrationCurrent Controlled Trials ISRCTN62761948, ISRCTN84288072 and ISRCTN14774583.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Peter Bartlett
- School of Law and Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Caroline Clements
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Linda Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Fiona Holland
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Nav Kapur
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Manchester Mental Health & Social Care NHS Trust, Manchester, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Rita Long
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Chris Roberts
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Dionysios Ntais
- Institute of Population Health, University of Manchester, Manchester, UK
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Socio-demographic and clinical characterization of patients with Bipolar Disorder I vs II: a Nationwide Italian Study. Eur Arch Psychiatry Clin Neurosci 2018; 268:169-177. [PMID: 28365865 DOI: 10.1007/s00406-017-0791-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 03/06/2017] [Indexed: 01/16/2023]
Abstract
Bipolar disorders (BDs) are prevalent, comorbid and disabling conditions, associated with the highest suicide risk among psychiatric illnesses. In the last few years, new efforts to better characterize the socio-demographic and clinical profiles of BD type I vs II have been documented by several reports, with novel and insightful findings in the field. The present multicenter study aimed to provide a comprehensive and reliable representation of the Italian reality, through the analysis of the largest national sample of bipolar patients collected so far. A total of 1500 patients (BD I n = 963 and BD II n = 537) from different psychiatric departments, participating in the Italian Chapter of the "International Society of Bipolar Disorders" (ISBD), were assessed and divided into two groups on the basis of their diagnostic subtype, and different socio-demographic and clinical variables were compared between the two subgroups. Chi-squared tests for categorical variables and t tests for continuous variables were performed for group comparison. Furthermore, a multivariable logistic regression was performed, considering diagnostic bipolar subtype (type I or II) as dependent variable, and socio-demographic/clinical characteristics as independent variables. BD I vs II patients showed an overall less favorable socio-demographic and clinical profile. In addition, the multivariable logistic regression showed that BD II vs BD I was predicted by the absence of lifetime suicide attempts (OR = 1.58, p = 0.01), a later age of diagnosis (OR = 1.03, p < 0.01), less hypomanic episodes in the last year (OR = 2.29, p < 0.0001) and absence of psycho-educational interventions in the last year (OR = 0.51, p < 0.01). BD I and II patients were found to significantly differ in relation to specific clinical variables, which should be considered within updated diagnostic-therapeutic algorithms.
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Roberts SE, John A, Kandalama U, Williams JG, Lyons RA, Lloyd K. Suicide following acute admissions for physical illnesses across England and Wales. Psychol Med 2018; 48:578-591. [PMID: 28714426 PMCID: PMC5964467 DOI: 10.1017/s0033291717001787] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 05/30/2017] [Accepted: 06/06/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries. METHODS Record linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital. RESULTS There were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6-1.8) and 131 in Wales (SMR = 2.0; 1.7-2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections. CONCLUSIONS There is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.
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Affiliation(s)
- S E Roberts
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - A John
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - U Kandalama
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - J G Williams
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - R A Lyons
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
| | - K Lloyd
- Swansea University Medical School,Singleton Park,Swansea University,Swansea,UK
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44
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Positive and Negative Suicide Ideation (PANSI) Inventory: Initial Psychometric Properties as a Suicide Risk Screening Tool Among Nigerian University Students. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1179557317751910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: The objective of this study is to examine the factor structure, validity, reliability, and the screening properties as a suicide risk assessment tool of the 14-item Positive and Negative Suicide Ideation (PANSI) in a nonclinical sample of Nigerian university students. Methods: A total of 514 students completed the PANSI, in addition to the Beck Depression Inventory-II (BDI-II) and the General Health Questionnaire-12 (GHQ-12). Results: Prior to the factor analysis, the sample was randomly divided into two. In one half of the sample (sample 1), exploratory factor analysis of the inventory yielded a 2-factor model (Negative Suicide Ideation [PANSI-NSI] and Positive Ideation [PANSI-PI]), whereas confirmatory factor analysis in the other half (sample 2) produced a 2-factor model with indices of fitness that indicated a satisfactory model fit ( c2 = 93.8; df = 67; χ2/degree of freedom = 1.400; P = .017; goodness of fit index = 0.951; Tucker-Lewis index = 0.964; comparative fit index = 0.974; root mean square error of approximation = 0.040). The internal consistencies of the items of the PANSI-PI and PANSI-NSI subscales were 0.75 and 0.79, respectively. The construct validity of the 2 subscales was modestly satisfactory: PANSI-PI had negative correlations with the GHQ-12 ( r = −.239, P < .001) and the BDI-II ( r = −.190, P < .001), whereas the PANSI-NSI had positive correlations with the GHQ-12 ( r = .248, P < .001) and the BDI-II ( r = .376, P < .001). In addition, a cutoff total score of 17 on the PANSI-NSI was associated with the best sensitivity (80.0%) and specificity (92.5%) in the identification of those students who endorsed experiencing suicidal ideation (area under the curve = 0.82, 95% confidence interval = 0.58-1.00). Conclusions: The PANSI has exhibited satisfactory psychometric properties as a self-rated suicidal behavior assessment instrument in the evaluation of the positive and negative thoughts associated with suicidal ideation among Nigerian university students.
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Schaffer A, Weinstock LM, Sinyor M, Reis C, Goldstein BI, Yatham LN, Levitt AJ. Self-poisoning suicide deaths in people with bipolar disorder: characterizing a subgroup and identifying treatment patterns. Int J Bipolar Disord 2017; 5:16. [PMID: 28332123 PMCID: PMC5406320 DOI: 10.1186/s40345-017-0081-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/21/2017] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To characterize self-poisoning suicide deaths in BD compared to other suicide decedents. METHODS Extracted coroner data from all suicide deaths (n = 3319) in Toronto, Canada from 1998 to 2012. Analyses of demographics, clinical history, recent stressors, and suicide details were conducted in 5 subgroups of suicide decedents: BD self-poisoning, BD other methods, non-BD self-poisoning, non-BD other methods, and unipolar depression self-poisoning. Toxicology results for lethal and present substances were also compared between BD and non-BD self-poisoning subgroups as well as between BD and unipolar depression self-poisoning subgroups. RESULTS Among BD suicide decedents, self-poisoning was significantly associated with female sex, past suicide attempts, and comorbid substance abuse. In both the BD and non-BD self-poisoning groups, opioids were the most common class of lethal medication. For both groups, benzodiazepines and antidepressants were the most common medications present at time of death, and in 23% of the BD group, an antidepressant was present without a mood stabilizer or antipsychotic. Only 31% of the BD group had any mood stabilizer present, with carbamazepine being most common. No antidepressant, mood stabilizer, or antipsychotic was present in 15.5% of the BD group. Relative to unipolar depression self-poisoning group, the BD self-poisoning group evidenced higher proportion of previous suicide attempt(s) and psychiatry/ER visits in the previous week. CONCLUSION People with BD who die by suicide via self-poisoning comprise a distinct but understudied group. The predominant absence of guideline-concordant pharmacologic care comprises a crucial target for future policy and knowledge translation efforts.
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Affiliation(s)
- Ayal Schaffer
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON M4N 3M5 Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI USA
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG 52, Toronto, ON M4N 3M5 Canada
| | - Benjamin I. Goldstein
- Centre for Youth Bipolar Disorder, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony J. Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
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Harenski CL, Brook M, Kosson DS, Bustillo JR, Harenski KA, Caldwell MF, Van Rybroek GJ, Koenigs M, Decety J, Thornton DM, Calhoun VD, Kiehl KA. Socio-neuro risk factors for suicidal behavior in criminal offenders with psychotic disorders. Soc Cogn Affect Neurosci 2017; 12:70-80. [PMID: 28065894 PMCID: PMC5390707 DOI: 10.1093/scan/nsw164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/31/2016] [Indexed: 12/11/2022] Open
Abstract
Relative to the general population, individuals with psychotic disorders have a higher risk of suicide. Suicide risk is also elevated in criminal offenders. Thus, psychotic-disordered individuals with antisocial tendencies may form an especially high-risk group. We built upon prior risk analyses by examining whether neurobehavioral correlates of social cognition were associated with suicidal behavior in criminal offenders with psychotic disorders. We assessed empathic accuracy and brain structure in four groups: (i) incarcerated offenders with psychotic disorders and past suicide attempts, (ii) incarcerated offenders with psychotic disorders and no suicide attempts, (iii) incarcerated offenders without psychotic disorders and (iv) community non-offenders without psychotic disorders. Established suicide risk variables were examined along with empathic accuracy and gray matter in brain regions implicated in social cognition. Relative to the other groups, offenders with psychotic disorders and suicide attempts had lower empathic accuracy and smaller temporal pole volumes. Empathic accuracy and temporal pole volumes were significantly associated with suicide attempts independent of other risk variables. The results indicate that brain and behavioral correlates of social cognition may add incremental value to models of suicide risk.
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Affiliation(s)
- Carla L Harenski
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Michael Brook
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David S Kosson
- Department of Psychology, Rosalind Franklin University, Chicago, IL
| | - Juan R Bustillo
- Department of Psychiatry, University of New Mexico, Albuquerque, NM
| | - Keith A Harenski
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | | | | | - Michael Koenigs
- Department of Psychiatry, University of Wisconsin - Madison, Madison, WI
| | - Jean Decety
- Departments of Psychology and Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
| | | | - Vince D Calhoun
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA.,Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM
| | - Kent A Kiehl
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM
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Kassianos AP, Georgiou G, Papaconstantinou EP, Detzortzi A, Horne R. Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning. Front Psychol 2017; 8:1769. [PMID: 29075216 PMCID: PMC5641822 DOI: 10.3389/fpsyg.2017.01769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/25/2017] [Indexed: 01/29/2023] Open
Abstract
Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications ("apps") to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non-adherence. Theories like social cognition models can be useful in ensuring that patients' education, motivation, skills, beliefs, and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated.
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Affiliation(s)
- Angelos P. Kassianos
- Department of Applied Health Research, University College London, London, United Kingdom
| | | | | | | | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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48
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Suicidality is a common and serious feature of anti-N-methyl-D-aspartate receptor encephalitis. J Neurol 2017; 264:2378-2386. [DOI: 10.1007/s00415-017-8626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 01/17/2023]
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49
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Saffer BY, Klonsky ED. The Relationship of Self-reported Executive Functioning to Suicide Ideation and Attempts: Findings from a Large U.S.-based Online Sample. Arch Suicide Res 2017; 21:577-594. [PMID: 27440417 DOI: 10.1080/13811118.2016.1211042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An increasing number of studies demonstrate that individuals with a history of suicidality exhibit impaired executive functioning abilities. The current study examines whether these differences are linked to suicidal thoughts or suicidal acts-a crucial distinction given that most people who think about suicide will not act on their thoughts. A large online sample of U.S. participants with a history of suicide ideation (n = 197), suicide attempts (n = 166), and no suicidality (n = 180) completed self-report measures assessing executive functioning, suicide ideation and attempts; in addition, depression, self-efficacy, and history of drug abuse and brain injury were assessed as potential covariates. Individuals with recent suicide attempts reported significantly worse executive functioning than ideators. This difference was not accounted for by depression, self-efficacy, history of drug abuse or brain injury. Self-reported executive functioning may represent an important short-term risk factor for suicide attempts.
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50
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Bellivier F, Belzeaux R, Scott J, Courtet P, Golmard JL, Azorin JM. Anticonvulsants and suicide attempts in bipolar I disorders. Acta Psychiatr Scand 2017; 135:470-478. [PMID: 28190254 DOI: 10.1111/acps.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To identify risk factors for suicide attempts (SA) in individuals commencing treatment for a manic or mixed episode. METHOD A total of 3390 manic or mixed cases with bipolar disorder (BD) type I recruited from 14 European countries were included in a prospective, 2-year observational study. Poisson regression models were used to identify individual and treatment factors associated with new SA events. Two multivariate models were built, stratified for the presence or absence of prior SA. RESULTS A total of 302 SA were recorded prospectively; the peak incidence was 0-12 weeks after commencing treatment. In cases with a prior history of SA, risk of SA repetition was associated with younger age of first manic episode (P = 0.03), rapid cycling (P < 0.001), history of alcohol and/or substance use disorder (P < 0.001), number of psychotropic drugs prescribed (P < 0.001) and initiation of an anticonvulsant at study entry (P < 0.001). In cases with no previous SA, the first SA event was associated with rapid cycling (P = 0.02), lifetime history of alcohol use disorder (P = 0.02) and initiation of an anticonvulsant at study entry (P = 0.002). CONCLUSION The introduction of anticonvulsants for a recent-onset manic or mixed episode may be associated with an increased risk of SA. Further BD studies must determine whether this link is causal.
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Affiliation(s)
- F Bellivier
- Inserm, U1144, Paris, France.,Department of Psychiatry and Addition Medicine, Assistance Publique - Hôpitaux de Paris (APHP), GH Saint-Louis - Lariboisière - F. Widal, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, UMR-S 1144, Paris, France.,Fondation FondaMental, Créteil, France
| | - R Belzeaux
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
| | - J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK.,Centre for Affective Disorders, IPPN, Kings College, London, UK
| | - P Courtet
- Fondation FondaMental, Créteil, France.,INSERM U1061, University of Montpellier UM1, Montpellier, France.,Department of Emergency Psychiatry & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - J-L Golmard
- ER4/EA3974, Biostatistics Department, Université Paris 6 et APHP, UF de biostatistique, GH Pitié-Salpêtrière, Paris, France
| | - J-M Azorin
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France
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