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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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Gonda X, Dome P, Serafini G, Pompili M. How to save a life: From neurobiological underpinnings to psychopharmacotherapies in the prevention of suicide. Pharmacol Ther 2023; 244:108390. [PMID: 36940791 DOI: 10.1016/j.pharmthera.2023.108390] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023]
Abstract
The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, suicide is a highly complex biopsychosocial phenomenon, and in spite of several suicidal models developed in recent years and a high number of suicide risk factors identified, we still have neither a sufficient understanding of underpinnings of suicide nor adequate management strategies to reduce its prevalence. The present paper first overviews the background of suicidal behavior including its epidemiology, prevalence, age and gender correlations and its association with neuropsychiatric disorders as well as its clinical assessment. Then we give an overview of the etiological background, including its biopsychosocial contexts, genetics and neurobiology. Based on the above, we then provide a critical overview of the currently available intervention options to manage and reduce risk of suicide, including psychotherapeutic modalities, traditional medication classes also providing an up-to-date overview on the antisuicidal effects of lithium, as well as novel molecules such as esketamine and emerging medications and further molecules in development. Finally we give a critical overview on our current knowledge on using neuromodulatory and biological therapies, such as ECT, rTMS, tDCS and other options.
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Affiliation(s)
- Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
| | - Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Bhaskaran AS, Reddi VSK, Suchandra HH, Gowda GS, Muliyala KP. Predictors of future suicide attempts in individuals with high suicide risk admitted to an acute psychiatry suicide intervention unit in India. A survival analysis study. Asian J Psychiatr 2022; 78:103270. [PMID: 36252324 DOI: 10.1016/j.ajp.2022.103270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/29/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Determination of suicide vulnerability remains challenging in mental illness. Variability in risk factors identified compound its poor predictability. Longitudinal studies, offering more reliable indices of risk, from developing countries are conspicuously limited. Furthermore, research advances allude to inherent vulnerability. This study, the first of its kind from India, consequently aimed to delineate factors influencing subsequent attempts in mental illness and acute suicidality. METHOD Baseline and follow-up information (up to five years) was obtained from medical records of individuals (n = 130) with acute suicidality [recent attempt (first attempt/ reattempt) and high-risk ideators]. Variables were compared between individuals with, and without subsequent suicide attempts. Time to attempt and factors influencing the same was determined using survival analysis, and Cox proportional hazard for estimating the likelihood of a subsequent suicide attempt. RESULTS Median duration of follow up of the sample (n = 130) was 23 months. The sample comprised of individuals with a recent attempt (first-time attempt), recent reattempt and recent high-risk ideators. Subsequent suicide attempts were noted in 30 (23.1 %) patients. Baseline sociodemographic and clinical variables, including suicidality, could not differentiate individuals with a subsequent suicide attempt. Survival analysis indicated that 65 % of subsequent attempts occurred within 9 months of discharge. Family history of suicide and the presence of impulsive-aggressive traits were associated with both, reduced survival time and overall increased risk of a subsequent suicide attempt. CONCLUSION This study delineates both, the time frame associated with greatest risk, as well as individuals most likely to reattempt suicide. It thereby offers insights into potential windows of opportunity to mitigate prospective suicide risk. Strategies such as enhanced after-care and integrating specific interventions to attenuate impulsive-aggressive behaviors could be a focus to prevent future attempts, thereby decreasing rates of suicide amongst those with mental illness. Furthermore, the findings of this study reaffirm the role of factors that independently confer vulnerability to suicide. Traversing noted regional variations, the findings importantly reinforce the distinct pathophysiological underpinnings of suicide in mental illness.
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Affiliation(s)
| | | | - Hari Hara Suchandra
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India
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Which patients with bipolar depression receive antidepressant augmentation? Results from an observational multicenter study. CNS Spectr 2022; 27:731-739. [PMID: 34505564 DOI: 10.1017/s109285292100078x] [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] [Indexed: 01/29/2023]
Abstract
BACKGROUND To identify demographic and clinical characteristics of bipolar depressed patients who require antidepressant (AD) augmentation, and to evaluate the short- and long-term effectiveness and safety of this therapeutic strategy. METHODS One hundred twenty-two bipolar depressed patients were consecutively recruited, 71.7% of them received mood stabilizers (MS)/second-generation antipsychotics (SGA) with AD-augmentation and 28.3% did not. Patients were evaluated at baseline, and after 12 weeks and 15 months of treatment. RESULTS The AD-augmentation was significantly higher in patients with bipolar II compared with bipolar I diagnosis. Patients with MS/SGA + AD had often a seasonal pattern, depressive polarity onset, depressive index episode with anxious features, a low number of previous psychotic and (hypo)manic episodes and of switch. They had a low irritable premorbid temperament, a low risk of suicide attempts, and a low number of manic symptoms at baseline. After 12 weeks of treatment, 82% of patients receiving ADs improved, 58% responded and 51% remitted, 3.8% had suicidal thoughts or projects, 6.1% had (hypo)manic switch, and 4.1% needed hospitalization. During the following 12 months, 92% of them remitted from index episode, 25.5% did not relapse, and 11% needed hospitalization. Although at the start advantaged, patients with AD-augmentation, compared with those without AD-augmentation, did not significantly differ on any outcome as well on adverse events in the short- and long-term treatment. CONCLUSION Our findings indicate that ADs, combined with MS and/or SGA, are short and long term effective and safe in a specific subgroup for bipolar depressed patients.
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Mills J. Lithium: The Oldest-Known Metal in the Universe Can Prevent Suicide, and Nurses Should Be Using It More. Issues Ment Health Nurs 2022; 43:193-197. [PMID: 34797752 DOI: 10.1080/01612840.2021.1990584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Jeremy Mills
- Peninsula, a Division of Parkwest Medical Center, Knoxville, Tennessee, USA
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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: 41] [Impact Index Per Article: 13.7] [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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De Berardis D, Fornaro M, Valchera A, Cavuto M, Perna G, Di Nicola M, Serafini G, Carano A, Pompili M, Vellante F, Orsolini L, Fiengo A, Ventriglio A, Yong-Ku K, Martinotti G, Di Giannantonio M, Tomasetti C. Eradicating Suicide at Its Roots: Preclinical Bases and Clinical Evidence of the Efficacy of Ketamine in the Treatment of Suicidal Behaviors. Int J Mol Sci 2018; 19:E2888. [PMID: 30249029 PMCID: PMC6213585 DOI: 10.3390/ijms19102888] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 12/22/2022] Open
Abstract
Despite the continuous advancement in neurosciences as well as in the knowledge of human behaviors pathophysiology, currently suicide represents a puzzling challenge. The World Health Organization (WHO) has established that one million people die by suicide every year, with the impressive daily rate of a suicide every 40 s. The weightiest concern about suicidal behavior is how difficult it is for healthcare professionals to predict. However, recent evidence in genomic studies has pointed out the essential role that genetics could play in influencing person's suicide risk. Combining genomic and clinical risk assessment approaches, some studies have identified a number of biomarkers for suicidal ideation, which are involved in neural connectivity, neural activity, mood, as well as in immune and inflammatory response, such as the mammalian target of rapamycin (mTOR) signaling. This interesting discovery provides the neurobiological bases for the use of drugs that impact these specific signaling pathways in the treatment of suicidality, such as ketamine. Ketamine, an N-methyl-d-aspartate glutamate (NMDA) antagonist agent, has recently hit the headlines because of its rapid antidepressant and concurrent anti-suicidal action. Here we review the preclinical and clinical evidence that lay the foundations of the efficacy of ketamine in the treatment of suicidal ideation in mood disorders, thereby also approaching the essential question of the understanding of neurobiological processes of suicide and the potential therapeutics.
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Affiliation(s)
- Domenico De Berardis
- National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, "G. Mazzini" Hospital, p.zza Italia 1, 64100 Teramo, Italy.
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Michele Fornaro
- Polyedra Research Group, 64100 Teramo, Italy.
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine 'Federico II' Naples, 80121 Naples, Italy.
| | - Alessandro Valchera
- Polyedra Research Group, 64100 Teramo, Italy.
- Villa S. Giuseppe Hospital, Hermanas Hospitalarias, 63100 Ascoli Piceno, Italy.
| | - Marilde Cavuto
- Department of Theory, Analysis and Composition, Music Conservatory "L. Canepa", 07100 Sassari, Italy.
| | - Giampaolo Perna
- Hermanas Hospitalarias, FoRiPsi, Department of Clinical Neurosciences, Villa San Benedetto Menni, Albese con Cassano, 22032 Como, Italy.
- Department of Psychiatry and Neuropsychology, University of Maastricht, 6221 Maastricht, The Netherlands.
- Department of Psychiatry and Behavioral Sciences, Leonard Miller School of Medicine, University of Miami, Coral Gables, FL 33114, USA.
| | - Marco Di Nicola
- Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, 00118 Rome, Italy.
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy.
| | - Alessandro Carano
- NHS, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "Madonna Del Soccorso", A.S.U.R. 12, 63074 San Benedetto del Tronto, Italy.
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, 00118 Rome, Italy.
| | - Federica Vellante
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Laura Orsolini
- Polyedra Research Group, 64100 Teramo, Italy.
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, College Lane Campus, University of Hertfordshire, Hatfield SG141LZ, UK.
| | - Annastasia Fiengo
- Polyedra Research Group, 64100 Teramo, Italy.
- NHS, Department of Mental Health ASUR Marche AV5, Mental Health Unit, 63100 Ascoli Piceno, Italy.
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy.
| | - Kim Yong-Ku
- Department of Psychiatry, Korea University College of Medicine, Seoul 08826, Korea.
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Massimo Di Giannantonio
- Department of Neuroscience, Imaging and Clinical Science, Chair of Psychiatry, University "G. D'Annunzio", 66100 Chieti, Italy.
| | - Carmine Tomasetti
- Polyedra Research Group, 64100 Teramo, Italy.
- Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine 'Federico II' Naples, 80121 Naples, Italy.
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Carter DJ. Case Study: A Transactional Analysis Model for a Single Mother and Her Adult Child With Bipolar Disorder. Clin Case Stud 2018. [DOI: 10.1177/1534650118790811] [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] [Indexed: 11/16/2022]
Abstract
This case study describes a transactional analysis model based on the strain of a single mother with an adult son suffering from bipolar I disorder. The study examines interaction patterns within the clinical setting; the therapeutic view examines contextual factors that affect this mother and her adult son through assessment and recovery with transactional analysis therapy. The 16-session therapeutic experience of a client and his mother is presented. The subjects in the case study were administered the Sixteen Personality Factor Questionnaire (16PF) assessment tool during the second and 16th sessions. There was a significant change from pretest to posttest stens scores regarding increased scores in emotional stability from 2 (extremely low) to 4 (average), rule consciousness from 1 (extremely low) to 3 (moderately low), openness to change from 6 (average) to 8 (moderately high), and self-control from 1 (extremely low) to 4 (average). Decreased scores included apprehension from 9 (extremely high) to 7 (average) and tension from 6 (average) to 3 (moderately low). Behavioral changes after a 1-month follow-up included taking the bus to sign up for a college class, taking his medication as prescribed, getting a part-time job in the kitchen at the Veteran Administration Medical Center, and developing a budget to manage his disability check.
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Smith KA, Cipriani A. Lithium and suicide in mood disorders: Updated meta-review of the scientific literature. Bipolar Disord 2017; 19:575-586. [PMID: 28895269 DOI: 10.1111/bdi.12543] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Suicide and suicidal behaviour are increased in mood disorders, particularly bipolar disorders. Observational studies and small randomized controlled trials (RCTs) support the idea that taking lithium is associated with a reduction in these rates. This paper aims to review the best evidence for the effect of lithium on rates of suicide and self harm. METHODS We searched PubMed, PsycINFO, and the Cochrane Library systematically for systematic reviews and meta-analyses of RCTs of lithium and suicide and self harm published between January 1980 and June 2017. In the case of multiple publications on the same topic, only the most recent or most comprehensive review was considered. RESULTS A large number of reviews were identified, but only 16 publications were systematic reviews. Of these, three systematic reviews of lithium and suicide rates and one of lithium and self harm confined only to RCTs were identified. Despite some methodological concerns and heterogeneity in terms of participants, diagnoses, comparators, durations, and phase of illness, the evidence to date is overwhelmingly in favour of lithium as an antisuicidal agent, even balanced against any potential disadvantages of its use in regular clinical practice. CONCLUSIONS The anti-suicidal effects of lithium have been consistently reported over the past 40 years. The most robust evidence comes from RCTs, but these results are also discussed in the context of the difficulties in conducting high quality studies in this area, and the supporting evidence that observational and non-randomized studies can also provide. Given this evidence, however, the use of lithium is still underrepresented in clinical practice and should be incorporated more assertively into current guidelines.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Löfman S, Hakko H, Mainio A, Riipinen P. Affective disorders and completed suicide by self-poisoning, trend of using antidepressants as a method of self-poisoning. Psychiatry Res 2017. [PMID: 28628870 DOI: 10.1016/j.psychres.2017.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this research was to study the role and trend of antidepressant use as a method of suicide in completed self-poisoning suicides in patients with affective disorders during a 23-year follow up period. The data consisted of 483 completed self-poisoning suicides from 1988 to 2011 in the province of Oulu in Northern Finland (286 men and 197 women). Of the self-poisoning victims, 26.9% (n=130) had hospital-treated unipolar depression and 3.1% (n=15) hospital-treated bipolar disorder. Further, 53.8% (n=70) of those with unipolar depression and 53.3% (n=8) of those with bipolar depression died by suicide using antidepressants. During the 23-year follow-up period, the proportion of those using antidepressants doubled among all self-poisoning victims of suicide. A significant decline was observed in the use of tricyclic antidepressants in self- poisoning suicides while a linear increase was found in the use of SSRIs (selective serotonin reuptake inhibitors) and other antidepressants. During recent years one in five self-poisoning suicides involved the use of antiepileptics. A limitation of our study was that the psychiatric diagnoses only include hospital inpatient episodes. In conclusion, the use of new antidepressants has increased rapidly, but the risk of their use in self-poisoning suicide has perhaps been underestimated.
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Affiliation(s)
- Sanna Löfman
- University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O.Box 5000, 90014 Oulu, Finland; Oulu University Hospital, Department of Psychiatry, PL 26, 90029 OYS, Oulu, Finland.
| | - Helinä Hakko
- University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O.Box 5000, 90014 Oulu, Finland; Oulu University Hospital, Department of Psychiatry, PL 26, 90029 OYS, Oulu, Finland
| | - Arja Mainio
- University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O.Box 5000, 90014 Oulu, Finland; Oulu University Hospital, Department of Psychiatry, PL 26, 90029 OYS, Oulu, Finland
| | - Pirkko Riipinen
- University of Oulu, Institute of Clinical Medicine, Department of Psychiatry, P.O.Box 5000, 90014 Oulu, Finland
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11
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Bordelon S, Dinwiddie SH. Possible Antidotes for Suicide Risk: What Should We Tell Our Patients? Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170803-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kattimani S, Subramanian K, Sarkar S, Rajkumar RP, Balasubramanian S. History of Lifetime suicide attempt in bipolar I disorder: its correlates and effect on illness course. Int J Psychiatry Clin Pract 2017; 21:118-124. [PMID: 27854557 DOI: 10.1080/13651501.2016.1250912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To identify the prevalence and correlates of bipolar I patients with a lifetime history of suicide attempt. MATERIALS AND METHODS Bipolar I disorder was diagnosed in 150 patients as per DSM-IV-TR criteria. Their lifetime suicide risk was assessed using the Columbia Suicide Severity Rating Scale. NIMH retrospective Life Chart Methodology was used to chart the illness course. Medication Adherence Rating Scale (MARS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the recent adherence and subjective sleep quality, respectively. The suicide attempters were compared with non-attempters on individual variables. RESULTS Around 23% had a positive lifetime history of suicide attempt. They were predominantly female, had an index (first ever) episode of depression, spent more proportion of time being ill, especially in depressive or mixed episode phase. Comorbid substance use disorder along with suicidal attempts was seen only in males. Suicide attempters displayed poor medication adherence attitudes for medications taken during the past week and reported impaired sleep quality for the previous month. CONCLUSIONS A positive history of lifetime suicide attempt was significantly associated with a worse course of bipolar I disorder. Effective treatment of depressive episodes, addressing non-adherence, substance use and sleep problems can reduce the suicide risk in such patients. Retrospective design of the study and recall bias are some of the limitations.
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Affiliation(s)
- Shivanand Kattimani
- a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India
| | - Karthick Subramanian
- a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India
| | - Siddharth Sarkar
- b Department of Psychiatry , All India Institute of Medical Sciences , New Delhi , India
| | - Ravi Philip Rajkumar
- a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India
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Grunebaum MF, Ellis SP, Keilp JG, Moitra VK, Cooper TB, Marver JE, Burke AK, Milak MS, Sublette ME, Oquendo MA, Mann JJ. Ketamine versus midazolam in bipolar depression with suicidal thoughts: A pilot midazolam-controlled randomized clinical trial. Bipolar Disord 2017; 19:176-183. [PMID: 28452409 DOI: 10.1111/bdi.12487] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/12/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate feasibility and effects of a sub-anesthetic infusion dose of ketamine versus midazolam on suicidal ideation in bipolar depression. Neurocognitive, blood and saliva biomarkers were explored. METHODS Sixteen participants with bipolar depression and a Scale for Suicidal Ideation (SSI) score of ≥4 were randomized to ketamine (0.5 mg/kg) or midazolam (0.02 mg/kg). Current pharmacotherapy was maintained excluding benzodiazepines within 24 hours. The primary clinical outcome was SSI score on day 1 post-infusion. RESULTS Results supported feasibility. Mean reduction of SSI after ketamine infusion was almost 6 points greater than after midazolam, although this was not statistically significant (estimate=5.84, SE=3.01, t=1.94, P=.074, 95% confidence interval ([CI)]=-0.65 to 12.31). The number needed to treat for response (SSI <4 and at least 50% below baseline) was 2.2, and for remission (SSI=0) was 3.2. The strongest neurocognitive correlation was between memory improvement on the Selective Reminding Test (SRT) and reduction in SSI score on day 1 after ketamine (ρ=-.89, P=.007). Pre- to post-infusion decrease in serum brain derived neurotrophic factor (BDNF) correlated with reduction in SSI from baseline to day 1 after ketamine (n=5, ρ=0.90, P=.037) but not midazolam (P=.087). CONCLUSIONS The study demonstrated feasibility. Suicidal thoughts were lower after ketamine than after midazolam at a trend level of significance, likely due to the small pilot sample. Memory improvement and BDNF are promising biomarkers. Replication is needed in an adequately powered full-scale trial.
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Affiliation(s)
- Michael F Grunebaum
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | - Steven P Ellis
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | - John G Keilp
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | | | - Thomas B Cooper
- Analytical Psychopharmacology Laboratory, Nathan Kline Institute, Research Foundation for Mental Hygiene of New York State, Orangeburg, NY, USA
| | - Julia E Marver
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | - Ainsley K Burke
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | - Matthew S Milak
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
| | - Maria A Oquendo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J John Mann
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University Medical Center (CUMC) and New York State Psychiatric Institute, New York, NY, USA
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Geoffroy PA, Samalin L, Llorca PM, Curis E, Bellivier F. Influence of lithium on sleep and chronotypes in remitted patients with bipolar disorder. J Affect Disord 2016; 204:32-9. [PMID: 27318597 DOI: 10.1016/j.jad.2016.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/14/2016] [Accepted: 06/05/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Lithium (Li) is the first-line treatment for bipolar disorder (BD), but its mechanisms of action remain unknown. Although the chronobiological action of Li is well documented in animals, its effects on sleep and chronotypes in remitted BD patients have never been investigated. METHODS OPTHYMUM is a multicenter, cross-sectional, observational study conducted in France. We compared the sleep (Pittsburgh Sleep Quality Index, PSQI) and chronotypes (Composite Scale of Morningness, CSM) of 525 euthymic adult bipolar outpatients with (n=149) and without (n=376) current Li treatment. We used a general linear mixed-effects Poisson model to correct for age, gender, BD subtype, and mood symptoms. RESULTS In patients with BD type I, women taking Li had significantly lower PSQI (-23% [-37; -7]), but men did not (-4% [-20; +16]). Patients with BD I taking Li had better sleep efficiency (-40% [-61; -7]) and tended to better sleep duration scores (-42% [-68; +3]). A Li effect exists in women for both sleep duration and the use of night sedation (resp. -70% [-90; -10] and -37% [-60; +0.01]) but not in men (resp. -12% [-63;+113] and +9% [-31;+72]). No such associations were observed for BD II. No lithium effect was detected in the CSM score. LIMITATIONS No controls for other medications but no between-group differences for sedative or antidepressant intakes. CONCLUSIONS Euthymic BD I patients with Li have better sleep efficiency and longer sleep duration than those without Li. Women with Li have better sleep quality, longer sleep duration and less frequent use of night sedation.
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Affiliation(s)
- Pierre Alexis Geoffroy
- Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France; Fondation FondaMental, Créteil, France.
| | - Ludovic Samalin
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, EA 7280, University of Auvergne, Clermont-Ferrand, France; Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France; CHU Clermont-Ferrand, EA 7280, University of Auvergne, Clermont-Ferrand, France
| | - Emmanuel Curis
- Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; Faculté de Pharmacie de Paris, Laboratoire de biomathématiques, France; Département de biostatistique et d'informatique médicale, Hôpital Saint-Louis, APHP, Paris, France
| | - Frank Bellivier
- Inserm, U1144, Paris F-75006, France; Université Paris Descartes, UMR-S 1144, Paris F-75006, France; Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris F-75013, France; AP-HP, GH Saint-Louis - Lariboisière - F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris Cedex 10, France; Fondation FondaMental, Créteil, France
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15
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Do Atypical Antipsychotics Have Antisuicidal Effects? A Hypothesis-Generating Overview. Int J Mol Sci 2016; 17:ijms17101700. [PMID: 27727180 PMCID: PMC5085732 DOI: 10.3390/ijms17101700] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 12/30/2022] Open
Abstract
Modern antipsychotic drugs are employed increasingly in the treatment of mood disorders as well as psychoses, stimulating interest in their possible contributions to altering suicidal risk. Clozapine remains the only treatment with an FDA-recognized indication for reducing suicidal risk (in schizophrenia). We carried out a systematic, computerized search for reports of studies involving antipsychotic drug treatment and suicidal behaviors. A total of 19 reports provide data with preliminary support for potential suicide risk-reducing effects of olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in addition to clozapine, and provide some support for antipsychotic drug treatment in general. These preliminary findings encourage further testing of antipsychotics for effects on suicidal behavior, making use of explicit, pre-planned assessments of suicidal behavior.
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16
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Abstract
Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with substantial evidence of preventive effects on suicidal behavior is long-term treatment with lithium. It is unclear whether this effect is specifically antisuicidal or reflects beneficial effects of lithium on depression, mood instability, and perhaps aggression and impulsivity. Antisuicidal effects of anticonvulsant mood stabilizers (carbamazepine, lamotrigine, valproate) appear to be less than with lithium. Further evaluation is needed for potential antisuicidal effects of atypical antipsychotics with growing evidence of efficacy in depression, particularly acute bipolar depression, while generally lacking risk of inducing agitation, mania, or mood instability. Short-term and long-term value and safety of antidepressants are relatively secure for unipolar depression but uncertain and poorly tested for bipolar depression; their effects on suicidal risk in unipolar depression may be age-dependent. Sedative anxiolytics are virtually unstudied as regards suicidal risks. Adequate management of suicidal risks in mood disorder patients requires comprehensive, clinically skillful monitoring and timely interventions.
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17
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Benard V, Vaiva G, Masson M, Geoffroy P. Lithium and suicide prevention in bipolar disorder. Encephale 2016; 42:234-41. [DOI: 10.1016/j.encep.2016.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/27/2015] [Indexed: 11/16/2022]
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18
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Moreira J, Geoffroy PA. Lithium and bipolar disorder: Impacts from molecular to behavioural circadian rhythms. Chronobiol Int 2016; 33:351-73. [DOI: 10.3109/07420528.2016.1151026] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Beyer JL, Weisler RH. Suicide Behaviors in Bipolar Disorder: A Review and Update for the Clinician. Psychiatr Clin North Am 2016; 39:111-23. [PMID: 26876322 DOI: 10.1016/j.psc.2015.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Suicide behaviors (ideation, attempts, and completions) are unfortunately common in patients with bipolar disorder. It is estimated that 25 to 50% attempt suicide at least once during their lifetime, and 6% to 19% complete suicide. Risk factors include a family history of suicide, previous suicide attempts, younger age of onset, comorbid psychiatric illnesses, and psychological constructs like hopelessness. Pharmacologic treatment may impact suicidal behaviors, either increasing vulnerability or resilience. Clinicians need to be particularly sensitive to their patient's thoughts and beliefs about death, particularly during stressful times of life or when in a depressive/mixed episode of bipolar disorder.
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Affiliation(s)
- John L Beyer
- Duke University Medical Center, Box 3519, Durham, NC 27710, USA.
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20
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Schaffer A, Isometsä ET, Azorin JM, Cassidy F, Goldstein T, Rihmer Z, Sinyor M, Tondo L, Moreno DH, Turecki G, Reis C, Kessing LV, Ha K, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:1006-20. [PMID: 26175498 PMCID: PMC5858693 DOI: 10.1177/0004867415594428] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Many factors influence the likelihood of suicide attempts or deaths in persons with bipolar disorder. One key aim of the International Society for Bipolar Disorders Task Force on Suicide was to summarize the available literature on the presence and magnitude of effect of these factors. METHODS A systematic review of studies published from 1 January 1980 to 30 May 2014 identified using keywords 'bipolar disorder' and 'suicide attempts or suicide'. This specific paper examined all reports on factors putatively associated with suicide attempts or suicide deaths in bipolar disorder samples. Factors were subcategorized into: (1) sociodemographics, (2) clinical characteristics of bipolar disorder, (3) comorbidities, and (4) other clinical variables. RESULTS We identified 141 studies that examined how 20 specific factors influenced the likelihood of suicide attempts or deaths. While the level of evidence and degree of confluence varied across factors, there was at least one study that found an effect for each of the following factors: sex, age, race, marital status, religious affiliation, age of illness onset, duration of illness, bipolar disorder subtype, polarity of first episode, polarity of current/recent episode, predominant polarity, mood episode characteristics, psychosis, psychiatric comorbidity, personality characteristics, sexual dysfunction, first-degree family history of suicide or mood disorders, past suicide attempts, early life trauma, and psychosocial precipitants. CONCLUSION There is a wealth of data on factors that influence the likelihood of suicide attempts and suicide deaths in people with bipolar disorder. Given the heterogeneity of study samples and designs, further research is needed to replicate and determine the magnitude of effect of most of these factors. This approach can ultimately lead to enhanced risk stratification for patients with bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology, and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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21
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Schaffer A, Isometsä ET, Tondo L, Moreno DH, Sinyor M, Kessing LV, Turecki G, Weizman A, Azorin JM, Ha K, Reis C, Cassidy F, Goldstein T, Rihmer Z, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Yatham L. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry 2015; 49:785-802. [PMID: 26185269 PMCID: PMC5116383 DOI: 10.1177/0004867415594427] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with elevated risk of suicide attempts and deaths. Key aims of the International Society for Bipolar Disorders Task Force on Suicide included examining the extant literature on epidemiology, neurobiology and pharmacotherapy related to suicide attempts and deaths in bipolar disorder. METHODS Systematic review of studies from 1 January 1980 to 30 May 2014 examining suicide attempts or deaths in bipolar disorder, with a specific focus on the incidence and characterization of suicide attempts and deaths, genetic and non-genetic biological studies and pharmacotherapy studies specific to bipolar disorder. We conducted pooled, weighted analyses of suicide rates. RESULTS The pooled suicide rate in bipolar disorder is 164 per 100,000 person-years (95% confidence interval = [5, 324]). Sex-specific data on suicide rates identified a 1.7:1 ratio in men compared to women. People with bipolar disorder account for 3.4-14% of all suicide deaths, with self-poisoning and hanging being the most common methods. Epidemiological studies report that 23-26% of people with bipolar disorder attempt suicide, with higher rates in clinical samples. There are numerous genetic associations with suicide attempts and deaths in bipolar disorder, but few replication studies. Data on treatment with lithium or anticonvulsants are strongly suggestive for prevention of suicide attempts and deaths, but additional data are required before relative anti-suicide effects can be confirmed. There were limited data on potential anti-suicide effects of treatment with antipsychotics or antidepressants. CONCLUSION This analysis identified a lower estimated suicide rate in bipolar disorder than what was previously published. Understanding the overall risk of suicide deaths and attempts, and the most common methods, are important building blocks to greater awareness and improved interventions for suicide prevention in bipolar disorder. Replication of genetic findings and stronger prospective data on treatment options are required before more decisive conclusions can be made regarding the neurobiology and specific treatment of suicide risk in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Task Force on Suicide, The International Society for Bipolar Disorders (ISBD), Pittsburgh, PA, USA; Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erkki T Isometsä
- Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy; Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - Doris H Moreno
- Section of Psychiatric Epidemiology and Mood Disorders Unit, Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lars Vedel Kessing
- Psychiatric Center Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gustavo Turecki
- Research and Academic Affairs, Department of Psychiatry, McGill University, Montréal, QC, Canada; McGill Group for Suicide Studies, Montréal, QC, Canada; Depressive Disorders Program, Douglas Institute, Montréal, QC, Canada; Departments of Psychiatry, Human Genetics, and Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Abraham Weizman
- Laboratory of Biological Psychiatry, The Felsenstein Medical Research Center, Petah Tikva, Israel; Research Unit, Geha Mental Health Center, Petah Tikva, Israel; Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jean-Michel Azorin
- Department of Adult Psychiatry, Sainte Marguerite Hospital, Marseille, France; University of Aix-Marseille II, Marseille, France
| | - Kyooseob Ha
- Mood Disorders Clinic and Affective Neuroscience Laboratory, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Korea Association for Suicide Prevention, Seoul, Republic of Korea
| | - Catherine Reis
- Mood and Anxiety Disorders Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frederick Cassidy
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioural Sciences, Duke University, Durham, NC, USA
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health, and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Section of Psychosomatic Medicine, Department of Psychiatry, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
| | - Nancy Diazgranados
- Laboratory of Clinical and Translational Studies, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, Bethesda, MD, USA
| | - Lakshmi Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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22
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Schaffer A, Isometsä ET, Tondo L, Moreno D, Turecki G, Reis C, Cassidy F, Sinyor M, Azorin JM, Kessing LV, Ha K, Goldstein T, Weizman A, Beautrais A, Chou YH, Diazgranados N, Levitt AJ, Zarate CA, Rihmer Z, Yatham LN. International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disord 2015; 17:1-16. [PMID: 25329791 PMCID: PMC6296224 DOI: 10.1111/bdi.12271] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/05/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attempts' or 'suicide', was conducted, and data extracted for analysis from all eligible articles. Demographic and clinical variables for which ≥ 3 studies with usable data were available were meta-analyzed using fixed or random-effects models for association with suicide attempts and suicide deaths. There was considerable heterogeneity in the methods employed by the included studies. RESULTS Variables significantly associated with suicide attempts were: female gender, younger age at illness onset, depressive polarity of first illness episode, depressive polarity of current or most recent episode, comorbid anxiety disorder, any comorbid substance use disorder, alcohol use disorder, any illicit substance use, comorbid cluster B/borderline personality disorder, and first-degree family history of suicide. Suicide deaths were significantly associated with male gender and first-degree family history of suicide. CONCLUSIONS This paper reports on the presence and magnitude of the correlates of suicide attempts and suicide deaths in bipolar disorder. These findings do not address causation, and the heterogeneity of data sources should limit the direct clinical ranking of correlates. Our results nonetheless support the notion of incorporating diagnosis-specific data in the development of models of understanding suicide in bipolar disorder.
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Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Erkki T Isometsä
- Institute of Clinical Medicine University of Helsinki, Helsinki, Finland
| | - Leonardo Tondo
- Lucio Bini Center, Cagliari, Italy and Harvard Medical School, McLean Hospital, Boston, MA, USA
| | - Doris Moreno
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Gustavo Turecki
- Departments of Psychiatry, Human Genetics, and Neurology & Neurosurgery, McGill University, Montreal, QC, Canada
| | - Catherine Reis
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Frederick Cassidy
- Department of Psychiatry and Behavioural Sciences, Duke University, Durham, USA
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Michel Azorin
- Department of Psychiatry, University of Aix-Marseille II, Marseille, France
| | - Lars Vedel Kessing
- Faculty of Health Sciences, University of Copenhagen, Psychiatric Center Copenhagen Department, Copenhagen, Denmark
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University, Bundang Hospital, Seoul, Republic of Korea
| | - Tina Goldstein
- Department of Child and Adolescent Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abraham Weizman
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Annette Beautrais
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Yuan-Hwa Chou
- Department of Psychiatry, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | | | - Anthony J Levitt
- Department of Psychiatry, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Zoltán Rihmer
- Department of Clinical and Theoretical Mental Health and Department of Psychiatry and Psychotherapy, Semmelweis Medical University, Budapest, Hungary
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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23
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Lopez-Castroman J, Courtet P, Baca-Garcia E, Oquendo MA. Identification of suicide risk in bipolar disorder. Bipolar Disord 2015; 17:22-3. [PMID: 25346206 DOI: 10.1111/bdi.12264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 08/19/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Jorge Lopez-Castroman
- Department of Emergency Psychiatry, CHRU Montpellier, Montpellier, France; IIS-Fundacion Jimenez Diaz, Department of Psychiatry, CIBERSAM, Madrid, Spain
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Tundo A, Calabrese JR, Proietti L, de Filippis R. Short-term antidepressant treatment of bipolar depression: are ISBD recommendations useful in clinical practice? J Affect Disord 2015; 171:155-60. [PMID: 25305430 DOI: 10.1016/j.jad.2014.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/13/2014] [Accepted: 09/18/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The study aimed to test the effectiveness of the ISBD Guidelines for short-term AD treatment of BP depression. METHODS The study sample included 255 patients with mood disorders (154 UP, 49 BP-I, 52 BP-II). Response was defined as a HDRS21 total score<7 at 12 weeks of treatment and remission as a ≥50% reduction of baseline HDRS21 total score sustained for 8 weeks. RESULTS Response was achieved by 64.9% of patients with UP disorder, 75.5% of patients with BP-I disorder and 75.0% with BP-II disorder without significant differences (χ²=3.0, p=0.219). The remission rate did not differ significantly among groups (χ²=3.8, p=0.151). The dropout rate was significantly higher for patients with UP (18.2%) than for patients with BP-I (2%) and BP-II (7.7%) disorder (χ²=10.1, p=0.006). Concerning AD safety, one patient with BP-I depression committed a suicide attempt and AD-emerging switch was observed in 2.9% of patients, 2 with BP-I and 1 with BP-II disorder. LIMITATIONS The observational nature of the study and unblinded outcomes assessment. CONCLUSIONS Our findings confirm the usefulness of ISBD Guidelines for short-term AD treatment of BP depression. These patients appear to have similar response and remission rate to those observed in UP depression and do not exhibit significant switch rates or risk of suicide. Our results are limited to patients with pure bipolar depression (excluding those with broadly defined mixed states), treated with ADs-mood stabilizers combination. We suggest to partially modify ISBD Recommendations 1 and 4, to include potential responders and to improve safety.
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Affiliation(s)
| | - Joseph R Calabrese
- Department of Psychiatry, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
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25
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Isometsä E, Sund R, Pirkola S. Post-discharge suicides of inpatients with bipolar disorder in Finland. Bipolar Disord 2014; 16:867-74. [PMID: 25056223 DOI: 10.1111/bdi.12237] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/09/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Suicide risk in psychiatric inpatients is known to be remarkably high after discharge. However, temporal patterns and risk factors among patients with bipolar disorder remain obscure. We investigated post-discharge temporal patterns of hazard and risk factors by type of illness phase among patients with bipolar disorder. METHODS Based on national registers, all discharges of patients with bipolar disorder from a psychiatric ward in Finland in 1987-2003 (n = 52,747) were identified, and each patient was followed up to post-index discharge or to suicide (n = 466). For discharges occurring in 1995-2003 (n = 35,946), factors modifying hazard of suicide during the first 120 days (n = 129) were investigated. RESULTS The temporal pattern of suicide risk depended on the type of illness phase, being highest but steeply declining after discharge with depression; less high and declining in mixed states; lower and relatively stable after mania. In Cox models, for post-discharge suicides (n = 65) after hospitalizations for bipolar depression (n = 9,635), the hazard ratio was 8.05 (p = 0.001) after hospitalization with a suicide attempt and 3.63 (p < 0.001) for male patients, but 0.186 (p = 0.001) for patients taking lithium. Suicides after mania (n = 28) or mixed episodes (n = 20) were predicted by male sex and preceding suicide attempts, respectively. CONCLUSIONS Among inpatients with bipolar disorder, suicide risk is high and related strongly to the time elapsed from discharge after hospitalizations for depressive episodes, and less strongly after hospitalizations for mixed episodes. Intra-episodic suicide attempts and male sex powerfully predict suicide risk. Lower suicide rate after hospitalizations for depression among patients prescribed lithium is consistent with a preventive effect.
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Affiliation(s)
- Erkki Isometsä
- Department of Psychiatry, University of Helsinki, Helsinki, Finland; Mood, Depression, and Suicidal Behavior Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital (HUCH), Helsinki, Finland
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Geoffroy PA, Etain B, Sportiche S, Bellivier F. Circadian biomarkers in patients with bipolar disorder: promising putative predictors of lithium response. Int J Bipolar Disord 2014; 2:28. [PMID: 26092399 PMCID: PMC4447721 DOI: 10.1186/2194-7511-2-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/26/2014] [Indexed: 11/11/2022] Open
Abstract
Bipolar disorder (BD) is a common, severe mental disorder with a high recurrence rate. Lithium (Li) is the cornerstone of BD treatments to reduce recurrence, suicide, and mortality risks. However, only 30% of patients treated with Li achieve complete remission, and few markers of the response to treatment have yet been identified for application in routine practice. Circadian biomarkers may be relevant predictors of individual responses to Li because (1) Li has been shown to affect circadian rhythms, (2) disrupted circadian rhythms are a core expression of susceptibility to BD, and (3) circadian abnormalities during euthymia are associated with relapses.
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Affiliation(s)
- Pierre Alexis Geoffroy
- />Inserm, U1144, Paris, F-75006 France
- />AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris CEDEX, 10 75475 France
- />Université Paris Diderot, UMR-S 1144, Paris, F-75013 France
- />Fondation FondaMental, Créteil, 94000 France
| | - Bruno Etain
- />Fondation FondaMental, Créteil, 94000 France
- />AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatrie, Créteil, 94000 France
- />INSERM, U955, Psychiatrie génétique, Créteil, 94000 France
| | - Sarah Sportiche
- />Inserm, U1144, Paris, F-75006 France
- />AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris CEDEX, 10 75475 France
- />Université Paris Diderot, UMR-S 1144, Paris, F-75013 France
- />Fondation FondaMental, Créteil, 94000 France
| | - Frank Bellivier
- />Inserm, U1144, Paris, F-75006 France
- />AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris CEDEX, 10 75475 France
- />Université Paris Diderot, UMR-S 1144, Paris, F-75013 France
- />Fondation FondaMental, Créteil, 94000 France
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27
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Is antiepileptic-induced suicidality a data-based class effect or an exaggeration? A comment on the literature. Harv Rev Psychiatry 2014; 22:379-81. [PMID: 25377614 DOI: 10.1097/hrp.0000000000000039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A few years ago the Food and Drug Administration, based on a meta-analysis, issued a warning stating that antiepileptic drugs (AEDs) are associated with an increased risk of suicidal ideation, suicide attempts, and completed suicide. This warning generated significant concern about the use of AEDs, especially in patients with epilepsy and affective disorders. Following the FDA report, several studies addressed this issue but only served to generate further concern and confusion. There seems to be no convincing data concerning a "class effect" of AEDs in inducing any type of suicide-related behaviors. Some data suggest a possible association of lamotrigine, levetiracetam, and topiramate with suicidality, but further research is needed. In any case, clinicians need to carefully assess suicidality in all patients treated with AEDs and inform them and their families on the possible increased risk of suicidality, though preferably in a way that keeps open the continuing use of AEDs.
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Zhang L, Di J. The transcriptional activator Ino2p dissociates from the yeast INM1 promoter in induction. DNA Cell Biol 2014; 33:863-8. [PMID: 25211324 DOI: 10.1089/dna.2014.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Mood stabilizers lithium and valproates are widely used in the treatment of bipolar disorder. It has been shown that these drugs can affect the inositol monophosphatase activity and thus the inositol de novo biosynthesis. However, the molecular mechanism of this action has thus far been vague. As such, characterizing the regulation of the gene encoding inositol monophosphatase at the molecular level can help to understand the bipolar disorder. As the model organism, the inositol monophosphatase is encoded by INM1 in Saccharomyces cerevisiae. In this study, we showed, using real-time reverse transcriptase polymerase chain reaction analysis, that INM1 is expressed in the presence of inositol, suggesting that the presence of inositol is required for INM1 transcriptional activation. We also demonstrated, using chromatin immunoprecipitation, that Ino2p is present at the promoter under uninduced conditions. Upon induction, Ino2p dissociates from the INM1 promoter. Furthermore, chromatin remodelers Ino80p and Snf2p are recruited to INM1 promoter upon induction as well as histone acetylases Gcn5p and Esa1p. Altogether, we have provided the evidence which describes how the transcriptional activator and coactivators participate in INM1 activation.
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Affiliation(s)
- Lingzhi Zhang
- 1 Department of Emergency, Shengjing Hospital of China Medical University , Shenyang, China
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Baethge C, Cassidy F. Fighting on the side of life: a special issue on suicide in bipolar disorder. Bipolar Disord 2013; 15:453-6. [PMID: 23919261 DOI: 10.1111/bdi.12097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher Baethge
- Department of Psychiatry and Psychotherapy; University of Cologne Medical School; Cologne; Germany
| | - Frederick Cassidy
- Department of Psychiatry and Behavioral Sciences; Duke University Medical School; Durham; NC; USA
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