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Chin Fatt CR, Ballard ED, Minhajuddin AT, Toll R, Mayes TL, Foster JA, Trivedi MH. Active suicidal ideation associated with dysfunction in default mode network using resting-state EEG and functional MRI - Findings from the T-RAD Study. J Psychiatr Res 2024; 176:240-247. [PMID: 38889554 DOI: 10.1016/j.jpsychires.2024.06.016] [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: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
Suicide in youth and young adults is a serious public health problem. However, the biological mechanisms of suicidal ideation (SI) remain poorly understood. The primary goal of these analyses was to identify the connectome profile of suicidal ideation using resting state electroencephalography (EEG). We evaluated the neurocircuitry of SI in a sample of youths and young adults (aged 10-26 years, n = 111) with current or past diagnoses of either a depressive disorder or bipolar disorder who were enrolled in the Texas Resilience Against Depression Study (T-RAD). Neurocircuitry was analyzed using orthogonalized power envelope connectivity computed from resting state EEG. Suicidal ideation was assessed with the 3-item Suicidal Thoughts factor of the Concise Health Risk Tracking self-report scale. The statistical pipeline involved dimension reduction using principal component analysis, and the association of neuroimaging data with SI using regularized canonical correlation analysis. From the original 111 participants and the correlation matrix of 4950 EEG connectivity pairs in each band (alpha, beta, theta), dimension reduction generated 1305 EEG connectivity pairs in the theta band, 2337 EEG pairs in the alpha band, and 914 EEG connectivity pairs in the beta band. Overall, SI was consistently involved with dysfunction of the default mode network (DMN). This report provides preliminary evidence of DMN dysfunction associated with active suicidal ideation in adolescents. Using EEG using power envelopes to compute connectivity moves us closer to using neurocircuit dysfunction in the clinical setting to identify suicidal ideation.
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Affiliation(s)
- Cherise R Chin Fatt
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Abu T Minhajuddin
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Russell Toll
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jane A Foster
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
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Schaffer A, Malhi GS. A new model for the prevention of suicide in bipolar disorder: Every patient, every setting, every provider. Bipolar Disord 2024; 26:309-312. [PMID: 38644491 DOI: 10.1111/bdi.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Affiliation(s)
- Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK
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Dempsey RC, Dodd AL, Gooding PA, Jones SH. The Types of Psychosocial Factors Associated with Suicidality Outcomes for People Living with Bipolar Disorder: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:525. [PMID: 38791740 PMCID: PMC11120682 DOI: 10.3390/ijerph21050525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024]
Abstract
Bipolar Disorder is associated with high rates of suicidal thoughts, behaviors, and outcomes, yet the lived experience of suicidality and Bipolar Disorder is not particularly well understood. Understanding the role of psychosocial aetiologies in suicidality outcomes for those living with Bipolar Disorder is key for developing appropriately targeted interventions focusing on factors that are amenable to change. In line with PRISMA guidance, we conducted a scoping review to identify the types of psychosocial factors studied in relation to the experience of suicidality for people living with Bipolar Disorder diagnoses. Systematic literature searches identified a sample of 166 articles from which key study data were extracted and charted. A narrative synthesis of the reviewed literature is presented ordered by the factors investigated across studies, a frequency count of the types of psychological/social aetiologies studied, and a brief overview of the key findings for each aetiology. Most of the identified literature took the form of quantitative cross-sectional studies, with only one qualitative study and 18 quantitative prospective studies. The most studied aetiologies were trauma (specifically early adverse experiences and childhood traumas) and stressful life events, impulsivity (primarily subjective self-reported trait impulsivity), social support and functioning, and personality/temperament factors. Only six studies in the final sample reported basing their research questions and/or hypotheses on an explicit theoretical model of suicide. The literature was primarily focused on using self-report measurements of key aetiologies and on factors which lead to worsened suicidality rather than focusing on potentially protective or buffering factors. Future research needs to better justify the aetiologies investigated in relation to suicidality outcomes for people living with Bipolar Disorder, including a firmer basis in theory and hypothesis testing, more prospective designs, and the use of alternative assessments of psychosocial aetiologies in addition to self-report questionnaires.
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Affiliation(s)
- Robert C. Dempsey
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Alyson L. Dodd
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Patricia A. Gooding
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Steven H. Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
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Kadriu B, Deng ZD, Kraus C, Johnston JN, Fijtman A, Henter ID, Kasper S, Zarate CA. The impact of body mass index on the clinical features of bipolar disorder: A STEP-BD study. Bipolar Disord 2024; 26:160-175. [PMID: 37536999 PMCID: PMC10839568 DOI: 10.1111/bdi.13370] [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] [Indexed: 08/05/2023]
Abstract
INTRODUCTION The effects of body mass index (BMI) on the core symptoms of bipolar disorder (BD) and its implications for disease trajectory are largely unexplored. OBJECTIVE To examine whether BMI impacted hospitalization rate, medical and psychiatric comorbidities, and core symptom domains such as depression and suicidality in BD. METHODS Participants (15 years and older) were 2790 BD outpatients enrolled in the longitudinal STEP-BD study; all met DSM-IV criteria for BD-I, BD-II, cyclothymia, BD NOS, or schizoaffective disorder, bipolar subtype. BMI, demographic information, psychiatric and medical comorbidities, and other clinical variables such as bipolarity index, history of electroconvulsive therapy (ECT), and history of suicide attempts were collected at baseline. Longitudinal changes in Montgomery-Åsberg Depression Rating Scale (MADRS) score, Young Mania Rating Scale (YMRS) score, and hospitalizations during the study were also assessed. Depending on the variable of interest, odds-ratios, regression analyses, factor analyses, and graph analyses were applied. RESULTS A robust increase in psychiatric and medical comorbidities was observed, particularly for baseline BMIs >35. A significant relationship was noted between higher BMI and history of suicide attempts, and individuals with BMIs >40 had the highest prevalence of suicide attempts. Obese and overweight individuals had a higher bipolarity index (a questionnaire measuring disease severity) and were more likely to have received ECT. Higher BMIs correlated with worsening trajectory of core depression symptoms and with worsening lassitude and inability to feel. CONCLUSIONS In BD participants, elevated BMI was associated with worsening clinical features, including higher rates of suicidality, comorbidities, and core depression symptoms.
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Affiliation(s)
- Bashkim Kadriu
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Zhi-De Deng
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Christoph Kraus
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
- Department of Psychiatry and Psychotherapy, Medical
University of Vienna, Vienna, Austria
| | - Jenessa N. Johnston
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
- Division of Medical Sciences, University of Victoria,
Victoria, BC, Canada
| | - Adam Fijtman
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Ioline D. Henter
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
| | - Siegfried Kasper
- Center for Brain Research Department of Molecular
Neuroscience, Medical University of Vienna, Vienna, Austria
| | - Carlos A. Zarate
- Section on the Neurobiology and Treatment of Mood
Disorders, National Institute of Mental Health, National Institutes of Health,
Bethesda, Maryland, U.S.A
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Wang H, Zhu R, Dai Z, Shao J, Xue L, Sun Y, Wang T, Liao Q, Yao Z, Lu Q. The altered temporal properties of dynamic functional connectivity associated with suicide attempt in bipolar disorders. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110898. [PMID: 38030032 DOI: 10.1016/j.pnpbp.2023.110898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/15/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The suicide risk in bipolar disorder (BD) is the highest among psychiatric disorders, and the neurobiological mechanism of suicide in BD remains unclear. The study aimed to investigate the underlying relevance between the implicated abnormalities of dynamic functional connectivity (FC) and suicide attempt (SA) in BD. METHODS We used the sliding window method to analyze the dynamic FC patterns from resting-state functional MRI data in 81 healthy controls (HC) and 114 BD patients (50 with SA and 64 with none SA). Then, the temporal properties of dynamic FC and the relationship between altered measures and clinical variables were explored. RESULTS We found that one of the five captured brain functional states was more associated with SA. The SA patients showed significantly increased fractional window and dwell time in the suicide-related state, along with increased number of state transitions compared with none SA (NSA). In addition, the connections within subcortical network-subcortical network (SubC-SubC), default mode network-subcortical network (DMN-SubC), and attention network-subcortical network (AN-SubC) were significantly changed in SA patients relative to NSA and HC in the suicide-related state. Crucially, the above-altered measures were significantly correlated with suicide risk. CONCLUSIONS Our findings suggested that the impaired dynamic FC within SubC-SubC, DMN-SubC, and AN-SubC were the important underlying mechanism in understanding SA for BD patients. It highlights the temporal properties of whole-brain dynamic FC could serve as the valuable biomarker for suicide risk assessment in BD.
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Affiliation(s)
- Huan Wang
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213164, China
| | - Rongxin Zhu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Junneng Shao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Li Xue
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Yurong Sun
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Ting Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Qian Liao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Zhijian Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing 210029, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing 210093, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China.
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Freitag S, Au JS, Liu DY, Mekawi Y, Lamis DA. Do bipolar disorder symptom profiles matter for suicide risk? A latent class approach to investigating differences in suicidal desire and acquired capability. Suicide Life Threat Behav 2024; 54:24-37. [PMID: 37937748 DOI: 10.1111/sltb.13013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Depressive and mixed symptoms in bipolar disorder (BD) have been linked to higher suicide risk. Based on Klonsky and May's three-step theory and Joiner's Interpersonal Psychological Theory of Suicide, we hypothesized that patients diagnosed with BD who reported severe levels of depressive symptoms and mixed depressive and manic symptoms would also report higher levels of suicidal desire and acquired capability of suicide, as well as suicidal thoughts and behaviors. METHODS The sample included 177 outpatients diagnosed with BD. Latent class analysis was conducted to replicate the identified groups of a previously conducted study using a smaller but overlapping dataset. Between-class and pairwise analyses with measures of suicidal desire and acquired capability were conducted. RESULTS As expected, the classes characterized by severe depressive symptoms and mixed symptoms reported higher levels of suicidal desire. However, the results regarding acquired capability were less consistent. CONCLUSION Given the overall elevated suicide risk of BD and the consistent relationship between depressive symptoms and other strong correlates of suicide, clinicians who work with patients diagnosed with BD should closely monitor changes in their depressive symptoms.
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Affiliation(s)
- Stephanie Freitag
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Josephine S Au
- Harvard T. H. Chan School of Public Health/Brigham and Women's Hospital/McLean Hospital, Boston, Massachusetts, USA
| | - Daphne Y Liu
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Yara Mekawi
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Feng S, Zhou S, Huang Y, Peng R, Han R, Li H, Yi Y, Feng Y, Ning Y, Han W, Zhang Z, Liu C, Li J, Wen X, Wu K, Wu F. Correlation between low frequency fluctuation and cognitive performance in bipolar disorder patients with suicidal ideation. J Affect Disord 2024; 344:628-634. [PMID: 37838272 DOI: 10.1016/j.jad.2023.10.031] [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: 02/21/2023] [Revised: 09/11/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Patients with bipolar disorder (BD) are at high risk of suicidal ideation (SI), and BD patients with suicidal ideation (BDSI) have shown marked abnormalities in spontaneous brain function. Cognitive impairment, on the other hand, is considered to be one of the core symptoms of BD. However, few studies have addressed the association between cognitive performance and abnormal spontaneous brain function in BDSI. METHODS In the current study, the MATRICS Consensus Cognitive Battery (MCCB) was used to assess cognitive performance in BDSI (n = 20), BD subjects without suicidal ideation (BDNSI) (n = 24) and healthy controls (HC) (n = 30). Their cognitive performance was then correlated with amplitude of low frequency fluctuation (ALFF) values obtained by resting-state functional magnetic resonance imaging (rs-fMRI). RESULTS We found that ALFF was significantly higher in the left precuneus and right posterior cingulate cortex in the BDSI group and significantly lower in the right precuneus in the BDNSI group than in the HC group. In addition, in the BDSI group, visual learning performance was positively correlated with ALFF values in the left precuneus. CONCLUSIONS Our findings support the notion that BD patients present with ALFF abnormalities, which are associated with cognitive performance in BDSI.
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Affiliation(s)
- Shixuan Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sumiao Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanyuan Huang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Runlin Peng
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, China
| | - Rui Han
- School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, China
| | - Hehua Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yun Yi
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yangdong Feng
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Han
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ziyun Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chenyu Liu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junhao Li
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xitong Wen
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kai Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; School of Biomedical Sciences and Engineering, South China University of Technology, Guangzhou International Campus, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China; National Engineering Research Center for Tissue Restoration and Reconstruction, South China University of Technology, Guangzhou, China; Guangdong Province Key Laboratory of Biomedical Engineering, South China University of Technology, Guangzhou, China; Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, Guangzhou, China.
| | - Fengchun Wu
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Department of Biomedical Engineering, Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Guangdong Engineering Technology Research Center for Diagnosis and Rehabilitation of Dementia, Guangzhou, China.
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Favril L, Yu R, Geddes JR, Fazel S. Individual-level risk factors for suicide mortality in the general population: an umbrella review. Lancet Public Health 2023; 8:e868-e877. [PMID: 37898519 PMCID: PMC10932753 DOI: 10.1016/s2468-2667(23)00207-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Deaths by suicide remain a major public health challenge worldwide. Identifying and targeting risk factors for suicide mortality is a potential approach to prevention. We aimed to summarise current knowledge on the range and magnitude of individual-level risk factors for suicide mortality in the general population and evaluate the quality of the evidence. METHODS In this umbrella review, five bibliographic databases were systematically searched for articles published from database inception to Aug 31, 2022. We included meta-analyses of observational studies on individual-level risk factors for suicide mortality in the general population. Biological, genetic, perinatal, and ecological risk factors were beyond the scope of this study. Effect sizes were synthesised and compared across domains. To test robustness and consistency of the findings, evidence for small-study effects and excess significance bias (ie, the ratio between the overall meta-analysis effect size and that of its largest included study) was examined, and prediction intervals were calculated. Risk of bias was assessed by the Risk of Bias in Systematic Reviews instrument. The protocol was pre-registered with PROSPERO (CRD42021230119). FINDINGS We identified 33 meta-analyses on 38 risk factors for suicide mortality in the general population. 422 (93%) of the 454 primary studies included in the meta-analyses were from high-income countries. A previous suicide attempt and suicidal ideation emerged as strong risk factors (with effect sizes ranging from 6 to 16). Psychiatric disorders were associated with a greatly elevated risk of suicide mortality, with risk ratios in the range of 4-13. Suicide risk for physical illnesses (such as cancer and epilepsy) and sociodemographic factors (including unemployment and low education) were typically increased two-fold. Contact with the criminal justice system, state care in childhood, access to firearms, and parental death by suicide also increased the risk of suicide mortality. Among risk factors for which sex-stratified analyses were available, associations were generally similar for males and females. However, the quality of the evidence was limited by excess significance and high heterogeneity, and prediction intervals suggested poor replicability for almost two-thirds of identified risk factors. INTERPRETATION A wide range of risk factors were identified across various domains, which underscores suicide mortality as a multifactorial phenomenon. Prevention strategies that span individual and population approaches should account for the identified factors and their relative strengths. Despite the large number of risk factors investigated, few associations were supported by robust evidence. Evidence of causal inference will need to be tested in high-quality study designs. FUNDING Wellcome Trust.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
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Tondo L, Vázquez GH, Baldessarini RJ. Prevention of Suicidal Behavior in Bipolar Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:402-411. [PMID: 38695004 PMCID: PMC11058958 DOI: 10.1176/appi.focus.23021025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
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.Reprinted from Bipolar Disord 2021; 23:14-23, with permission from John Wiley and Sons. Copyright © 2021.
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Affiliation(s)
- Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Tondo, Baldessarini); International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA (all authors); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Tondo); Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada (Vazquez)
| | - Gustavo H Vázquez
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Tondo, Baldessarini); International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA (all authors); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Tondo); Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada (Vazquez)
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA (Tondo, Baldessarini); International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA (all authors); Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy (Tondo); Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada (Vazquez)
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10
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Miola A, Tondo L, Pinna M, Contu M, Baldessarini RJ. Suicidal risk and protective factors in major affective disorders: A prospective cohort study of 4307 participants. J Affect Disord 2023; 338:189-198. [PMID: 37301296 DOI: 10.1016/j.jad.2023.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/25/2023] [Accepted: 06/04/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Suicidal behavior is strongly associated with major affective disorders, but there is a need to quantify and compare specific risk and protective factors in bipolar disorder (BD) and major depressive disorder (MDD). METHODS In 4307 extensively evaluated major affective-disorder participants with BD (n = 1425) or MDD (n = 2882) diagnosed by current international criteria, we compared characteristics among those with versus without suicidal acts from illness-onset through 8.24 years of follow-up. RESULTS Suicidal acts were identified in 11.4 % of participants; 25.9 % were violent and 6.92 % (0.79 % of all participants) were fatal. Associated risk factors included: diagnosis (BD > MDD), manic/psychotic features in first-episodes, family history of suicide or BD, separation/divorce, early abuse, young at illness-onset, female sex with BD, substance abuse, higher irritable, cyclothymic or dysthymic temperament ratings, greater long-term morbidity, and lower intake functional ratings. Protective factors included marriage, co-occurring anxiety disorder, higher ratings of hyperthymic temperament and depressive first episodes. Based on multivariable logistic regression, five factors remained significantly and independently associated with suicidal acts: BD diagnosis, more time depressed during prospective follow-up, younger at onset, lower functional status at intake, and women > men with BD. LIMITATIONS Reported findings may or may not apply consistently in other cultures and locations. CONCLUSIONS Suicidal acts including violent acts and suicides were more prevalent with BD than MDD. Of identified risk (n = 31) and protective factors (n = 4), several differed with diagnosis. Their clinical recognition should contribute to improved prediction and prevention of suicide in major affective disorders.
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Affiliation(s)
- Alessandro Miola
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Neuroscience, University of Padova, Padua, Italy.
| | - Leonardo Tondo
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Marco Pinna
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Martina Contu
- Lucio Bini Mood Disorder Centers, Cagliari & Rome, Italy
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders Research, Mailman Research Center, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Izadi N, Mitchell RHB, Giacobbe P, Nestor S, Steinberg R, Amini J, Sinyor M, Schaffer A. Suicide Assessment and Prevention in Bipolar Disorder: How Current Evidence Can Inform Clinical Practice. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:380-388. [PMID: 38695007 PMCID: PMC11058945 DOI: 10.1176/appi.focus.20230011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
Bipolar disorder is associated with a considerable risk of suicide, and this fact must be incorporated into management of all patients with the condition. This article highlights the importance of a more nuanced understanding of the factors associated with the increased risk of suicidal behavior in people diagnosed as having bipolar disorder and interventions that could mitigate it. Several sociodemographic, clinical, environmental, and other variables have been associated with suicide attempts or deaths in bipolar disorder. Youths with bipolar disorder are a particularly vulnerable group, and their trajectory of illness could be modified by early interventions. Several medications have been studied regarding their relationship to suicide risk in bipolar disorder, and interventional psychiatry is a newer area of research focus. Finally, community-based approaches can be incorporated into a comprehensive approach to suicide prevention. This article summarizes the current understanding of key variables that can help inform a clinical risk assessment of individuals and interventions that can be employed in suicide prevention in bipolar disorder.
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Affiliation(s)
- Niloofar Izadi
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Rachel H B Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Sean Nestor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Rosalie Steinberg
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Jasmine Amini
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, and Sunnybrook Research Institute, Toronto (all authors); Department of Psychiatry, University of Toronto, Toronto (Izadi, Mitchell, Giacobbe, Nestor, Steinberg, Sinyor, Schaffer)
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12
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Tian S, Zhu R, Chen Z, Wang H, Chattun MR, Zhang S, Shao J, Wang X, Yao Z, Lu Q. Prediction of suicidality in bipolar disorder using variability of intrinsic brain activity and machine learning. Hum Brain Mapp 2023; 44:2767-2777. [PMID: 36852459 PMCID: PMC10089096 DOI: 10.1002/hbm.26243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
Bipolar disorder (BD) is associated with marked suicidal susceptibility, particularly during a major depressive episode. However, the evaluation of suicidal risk remains challenging since it relies mainly on self-reported information from patients. Hence, it is necessary to complement neuroimaging features with advanced machine learning techniques in order to predict suicidal behavior in BD patients. In this study, a total of 288 participants, including 75 BD suicide attempters, 101 BD nonattempters and 112 healthy controls, underwent a resting-state functional magnetic resonance imaging (rs-fMRI). Intrinsic brain activity was measured by amplitude of low-frequency fluctuation (ALFF). We trained and tested a two-level k-nearest neighbors (k-NN) model based on resting-state variability of ALFF with fivefold cross-validation. BD suicide attempters had increased dynamic ALFF values in the right anterior cingulate cortex, left thalamus and right precuneus. Compared to other machine learning methods, our proposed framework had a promising performance with 83.52% accuracy, 78.75% sensitivity and 87.50% specificity. The trained models could also replicate and validate the results in an independent cohort with 72.72% accuracy. These findings based on a relatively large data set, provide a promising way of combining fMRI data with machine learning technique to reliably predict suicide attempt at an individual level in bipolar depression. Overall, this work might enhance our understanding of the neurobiology of suicidal behavior by detecting clinically defined disruptions in the dynamics of instinct brain activity.
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Affiliation(s)
- Shui Tian
- Department of RadiologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
- Laboratory for Artificial Intelligence in Medical Imaging (LAIMI)Nanjing Medical UniversityNanjingChina
| | - Rongxin Zhu
- Department of PsychiatryThe Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhilu Chen
- Department of PsychiatryThe Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Huan Wang
- School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Child Development and Learning ScienceKey Laboratory of Ministry of EducationBeijingChina
| | - Mohammad Ridwan Chattun
- Department of PsychiatryThe Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityNanjingChina
| | - Siqi Zhang
- School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Child Development and Learning ScienceKey Laboratory of Ministry of EducationBeijingChina
| | - Junneng Shao
- School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Child Development and Learning ScienceKey Laboratory of Ministry of EducationBeijingChina
| | - Xinyi Wang
- School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Child Development and Learning ScienceKey Laboratory of Ministry of EducationBeijingChina
| | - Zhijian Yao
- Department of PsychiatryThe Affiliated Nanjing Brain Hospital of Nanjing Medical UniversityNanjingChina
- Nanjing Brain HospitalMedical School of Nanjing UniversityNanjingChina
| | - Qing Lu
- School of Biological Sciences and Medical EngineeringSoutheast UniversityNanjingChina
- Child Development and Learning ScienceKey Laboratory of Ministry of EducationBeijingChina
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13
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Huber RS, Boxer D, Smith CJ, Renshaw PF, Yurgelun-Todd DA, Kondo DG. Detailed assessment of suicidal ideation in youth with bipolar disorder versus major depressive disorder. Bipolar Disord 2023; 25:200-208. [PMID: 36606348 PMCID: PMC10525907 DOI: 10.1111/bdi.13294] [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] [Indexed: 01/07/2023]
Abstract
OBJECTIVES There is a critical need to better understand the factors underlying the increased suicide risk for youth with bipolar disorder (BD) in order to develop targeted prevention efforts. This study aimed to examine differences in characteristics of suicide ideation (SI) in youth with BD compared to youth with major depressive disorder (MDD) that may be associated with increased suicide risk. METHODS One hundred and fifty-one participants (92 MDD and 59 BD), ages 13-21, completed a diagnostic interview and clinical assessments. Lifetime symptoms of SI and SA were assessed using the Columbia Suicide Severity Rating Scale. Ordinal logistic regression models were used to investigate whether the diagnostic group predicted the severity and intensity of the most severe or most common SI with the age of onset, age, and gender as covariates. RESULTS Compared to MDD youth, BD youth were more likely to report experiencing more severe SI, p = 0.039, experiencing the most severe SI more frequently, p = 0.002, having less control of the most severe SI, p = 0.012, and that deterrents were less likely to stop them from acting on the most severe SI, p = 0.006. CONCLUSION This study highlights differences in the severity and intensity of SI in youth with BD and suggests that youth with BD have greater difficulty inhibiting thoughts of SI which may lead to less resistance to suicide action. Findings underscore the need for a more detailed assessment of SI in youth with BD to better understand SI as a proximal risk factor for future SA and a potential target for intervention.
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Affiliation(s)
- Rebekah S. Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Danielle Boxer
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Calen J. Smith
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center, Salt Lake City, Utah, USA
| | - Deborah A. Yurgelun-Todd
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center, Salt Lake City, Utah, USA
| | - Douglas G. Kondo
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA
- U.S. Department of Veterans Affairs, Rocky Mountain Mental Illness Research, Education and Clinical Center, Salt Lake City, Utah, USA
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14
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Massalha Y, Maggioni E, Callari A, Brambilla P, Delvecchio G. A review of resting-state fMRI correlations with executive functions and social cognition in bipolar disorder. J Affect Disord 2023; 334:337-351. [PMID: 37003435 DOI: 10.1016/j.jad.2023.03.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Deficits in executive functions (EF) and social cognition (SC) are often observed in bipolar disorder (BD), leading to a severe impairment in engaging a functional interaction with the others and the surrounding environment. Therefore, in recent years, resting-state functional magnetic resonance imaging (rs-fMRI) studies on BD tried to identify the neural underpinnings of these cognitive domains by exploring the association between the intrinsic functional connectivity (FC) and the scores in clinical scales evaluating these domains. METHODS A bibliographic search on PubMed and Scopus of studies evaluating the correlations between rs-fMRI findings and EF and/or SC in BD was conducted until March 2022. Ten studies met the inclusion criteria. RESULTS Overall, the results of the reviewed studies showed that BD patients had FC deficits compared to healthy controls (HC) in selective resting-state networks involved in EF and SC, which include the default mode network, especially the link between medial prefrontal cortex and posterior cingulate cortex, and the sensory-motor network. Finally, it also emerged the predominant role of alterations in prefrontal connections in explaining the cognitive deficits in BD patients. LIMITATIONS The heterogeneity of the reviewed studies, in terms of cognitive domains explored and neuroimaging acquisitions, limited the comparability of the findings. CONCLUSIONS rs-fMRI studies could help deepen the brain network alterations underlying EF and SC deficits in BD, pointing the attention on the neuronal underpinning of cognition, whose knowledge may lead to the development of new neurobiological-based approaches to improve the quality of life of these patients.
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Affiliation(s)
- Yara Massalha
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20122 Milan, Italy
| | - Antonio Callari
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122 Milan, Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122 Milan, Italy
| | - Giuseppe Delvecchio
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, 20122 Milan, Italy.
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15
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Di Salvo G, Porceddu G, Albert U, Maina G, Rosso G. Correlates of long duration of untreated illness (DUI) in patients with bipolar disorder: results of an observational study. Ann Gen Psychiatry 2023; 22:12. [PMID: 36959643 PMCID: PMC10035162 DOI: 10.1186/s12991-023-00442-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Despite a high number of studies investigating the correlation between long Duration of Untreated Illness (DUI) and poor course of Bipolar Disorder (BD), the results concerning the impact of DUI on some specific factors, such as suicidality and medical comorbidities, are still inconsistent. This cross-sectional observational study aimed at analyzing potential socio-demographic and clinical correlates of long DUI in a large cohort of real-world, well-characterized BD patients. METHODS The socio-demographic and clinical characteristics of 897 patients with BD were collected. The sample was divided for analysis in two groups (short DUI vs long DUI) according to a DUI cutoff of 2 years. Comparisons were performed using χ2 tests for categorical variables and the Kruskal-Wallis test for continuous variables. Logistic regression (LogReg) was used to identify explanatory variables associated with DUI (dependent variable). RESULTS Six-hundred and sixty patients (75.5%) presented long DUI (> 2 years) and mean DUI was 15.7 years. The LogReg analysis confirmed the association of long DUI with bipolar II disorder (p: 0.016), lower age at onset (p < 0.001), depressive predominant polarity (p: 0.018), depressive polarity onset (p < 0.001), longer duration of illness (p < 0.001), lifetime suicide attempts (p: 0.045) and current medical comorbidities (p: 0.019). CONCLUSIONS The present study confirms the association between long DUI and higher risk of suicide attempts in patients with BD. Moreover, an association between long DUI and higher rates of medical conditions has been found.
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Affiliation(s)
- Gabriele Di Salvo
- San Luigi Gonzaga University Hospital, Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Giorgia Porceddu
- Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
- UCO Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano Isontina, ASUGI, Trieste, Italy
| | - Giuseppe Maina
- San Luigi Gonzaga University Hospital, Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | - Gianluca Rosso
- San Luigi Gonzaga University Hospital, Department of Neurosciences 'Rita Levi Montalcini', University of Turin, Turin, Italy.
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16
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Malhi GS, Das P, Outhred T, Bryant RA, Calhoun VD. An fMRI examination of the neural basis of suicide attempts: The role of mentalizing in the context of mood. Bipolar Disord 2022; 24:806-816. [PMID: 36164959 PMCID: PMC10092483 DOI: 10.1111/bdi.13261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Facial emotion recognition (FER) deficits in depressed mood disorder patients contribute to suicidality. Prior research shows that intrinsic brain activity patterns are altered by attempting suicide. Therefore, we investigated in depressed patients whether differences in FER contribute to their clinical symptoms of suicide. METHODS Neural activity in response to an FER task was compared across three groups: healthy controls (HCs, N = 66), suicide non-attempter (SNA, N = 50), suicide attempter (SA, N = 25). Modulation of brain networks by the task and functional connectivity (FC) within (using spatial map, spectral power) and between (using functional network connectivity; FNC) were examined. The contribution of these differences to suicidal symptoms in each group was also examined. RESULTS Patient groups displayed impaired FC both within and between networks but differed in nature and networks involved. They also showed differential modulation of networks by task, such that compared with both HC and SNA, SA displayed impaired FC within the default-mode network (DMN) and also its task modulation. In the SA group, FC within the DMN and FNC between two lateral prefrontal networks, and its interaction with the basal ganglia network contributed significantly to the clinical symptoms of suicide. CONCLUSIONS This study affirms differences between SA and SNA brain activity patterns and suggests that suicidal activity probably emanates via different mechanisms in these patient groups. Perhaps, over-attribution of emotion impairs one's self-referential thought processes and coupled with diminished emotional control this makes depressed individuals vulnerable to suicide.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,ARCHI, Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Pritha Das
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,ARCHI, Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,CADE Clinic, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,ARCHI, Sydney Medical School Northern, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia, USA
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17
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Which Clinical and Biochemical Parameters Are Associated with Lifetime Suicide Attempts in Bipolar Disorder? Diagnostics (Basel) 2022; 12:diagnostics12092215. [PMID: 36140615 PMCID: PMC9498201 DOI: 10.3390/diagnostics12092215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 08/26/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Bipolar Disorder (BD) is a disabling condition with suicidal behavior as one of the most common adverse outcomes. The purpose of the present research is to investigate the relationship between lifetime suicide attempts and the clinical factors/biochemical parameters in a large sample of bipolar patients. Methods: A total of 561 patients, consecutively hospitalized for BD in Milan and Monza (Italy), were recruited. Data about the demographic and clinical variables, as well as the values of blood analyses, were collected. The groups identified according to the presence/absence of lifetime suicide attempts were compared using univariate analyses. Then, three preliminary binary logistic regressions and a final logistic regression model were performed to identify the clinical and biochemical parameters associated with lifetime suicide attempts in BD. Results: Lifetime suicide attempts in BD were predicted by a longer duration of untreated illness (DUI) (p = 0.005), absence of lifetime psychotic symptoms (p = 0.025), presence of poly-substance use disorders (p = 0.033), comorbidity with obesity (p = 0.022), a last mood episode of manic polarity (p = 0.044), and lower bilirubin serum levels (p = 0.002); higher total cholesterol serum levels showed a trend toward statistical significance (p = 0.058). Conclusions: BD patients with lifetime suicide attempts present unfavorable clinical features. Some specific biochemical characteristics of bipolar patients may represent potential markers of suicidal behavior and need to be better investigated to identify new targets of treatment in the framework of personalized medicine. These preliminary findings have to be confirmed by further studies in different clinical settings.
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18
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Trivedi C, Vadukapuram R, Chaudhari G, Ashraf S, Tazin F, Mansuri Z, Jain S. Risk of Suicide in Patients With Bipolar Disorder Having Comorbid Chronic Pain Disorders: Insights From the Nationwide Inpatient Sample Data From 2016 to 2018. J Nerv Ment Dis 2022; 210:564-569. [PMID: 35394970 DOI: 10.1097/nmd.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Bipolar disorders (BDs) are associated with significant risk of suicide. BD patients (age ≥18 years) admitted to the hospital were identified from the National Inpatient Sample dataset. Based on the secondary diagnosis of chronic pain disorder (CPD), patients were stratified into two groups (1) BD with CPD (BD + CPD) and (2) BD without CPD (BD - CPD). Groups were matched (1:1) for the type of BD and compared for baseline characteristics and suicidal ideation/attempt (SI/SA). Compared with BD - CPD, most patients in the BD + CPD group were older (mean age, 47.6 vs. 40.4 years), female (58.4% vs. 55.2%), and white (77.2% vs. 66.7%). After adjusting for covariates, compared with the BD - CPD group, the BD + CPD group had 21% more risk of SI/SA (odds ratio, 1.21, p < 0.001). CPD is independently associated with the increased risk of suicide among patients with BD. Thus, comorbid CPD among patients admitted for BD can be an essential risk factor for suicide.
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Affiliation(s)
- Chintan Trivedi
- Texas Tech University Health Science Center at Permian Basin, Midland, Texas
| | | | - Gaurav Chaudhari
- Texas Tech University Health Science Center at Permian Basin, Midland, Texas
| | | | - Faria Tazin
- East Liverpool City Hospital, East Liverpool, Ohio
| | - Zeeshan Mansuri
- Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Shailesh Jain
- Texas Tech University Health Science Center at Permian Basin, Midland, Texas
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19
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Moller CI, Davey CG, Badcock PB, Wrobel AL, Cao A, Murrihy S, Sharmin S, Cotton SM. Correlates of suicidality in young people with depressive disorders: A systematic review. Aust N Z J Psychiatry 2022; 56:910-948. [PMID: 35362327 DOI: 10.1177/00048674221086498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders. METHOD Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines. RESULTS We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible. CONCLUSION Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.
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Affiliation(s)
- Carl I Moller
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher G Davey
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Paul B Badcock
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Anna L Wrobel
- Orygen, The University of Melbourne, Parkville, VIC, Australia
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Alice Cao
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Sean Murrihy
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
| | - Sonia Sharmin
- Department of Occupational Therapy, Social Work and Social Policy, La Trobe University, Bundoora, VIC, Australia
- Research and Evaluation, Take Two, Berry Street, Eaglemont, VIC, Australia
- Department of Public Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Sue M Cotton
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
- Orygen, The University of Melbourne, Parkville, VIC, Australia
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20
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Bloomfield-Clagett B, Greenstein DK, Zarate CA, Ballard ED. The association between variability, intensity, and persistence of suicidal ideation and prospective suicidal behavior in the systematic treatment enhancement program for bipolar disorder (STEP-BD) study. Int J Bipolar Disord 2022; 10:17. [PMID: 35773558 PMCID: PMC9247121 DOI: 10.1186/s40345-022-00263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study sought to examine the association between prospective suicidal behavior and variability, intensity, and persistence of suicidal ideation (SI) in bipolar disorder (BD). Methods Data were drawn from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a naturalistic study of 4360 outpatients 15 years or older with BD. In separate models, logistic regressions with suicidal behavior (first attempt or death by suicide) as the outcome variable and SI variability (fluctuating levels of SI over time, measured as ordinal dispersion of SI score), intensity (median SI score over time in study), or persistence (number of visits with reported SI) as the explanatory variables were used to examine the relationship between SI characteristics and odds of future suicidal behavior events. Results After adjusting for possible confounders, the odds of prospective suicidal behavior were 1.2 times greater per 10% increase in SI variability. SI persistence was not associated with suicidal behavior. For SI intensity, a median SI score of ‘rare/fleeting’ or ‘several days’ of SI was not associated with suicidal behavior, but the odds of prospective suicidal behavior were nearly five times greater for participants with the highest observed median SI intensity score of ‘nearly every day’. Conclusions The findings suggest that, in BD participants, monitoring SI variability may be clinically useful for assessing suicide risk. Supplementary Information The online version contains supplementary material available at 10.1186/s40345-022-00263-7.
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Affiliation(s)
- Bartholt Bloomfield-Clagett
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA
| | - Dede K Greenstein
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-5341, 10 Center Drive, MSC 1282, Bethesda, MD, 20892, USA.
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21
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Sanches M, Nguyen LK, Chung TH, Nestadt P, Wilcox HC, Coryell WH, Soares JC, Selvaraj S. Anxiety symptoms and suicidal thoughts and behaviors among patients with mood disorders. J Affect Disord 2022; 307:171-177. [PMID: 35331824 PMCID: PMC9321173 DOI: 10.1016/j.jad.2022.03.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Though the association between anxiety disorders and suicidal behavior is well-described, the impact of anxiety symptoms on suicidal thoughts and behaviors (STB) across different mood disorders is still unclear. METHODS We performed a registry-based retrospective study utilizing outcome measure data collected by the National Network of Depression Centers (NNDC), a nationwide nonprofit consortium of 26 leading clinical and academic member centers in the United States. The sample consisted of 2607 outpatients with mood disorders (major depressive disorder or bipolar disorders). Demographic and clinical variables were compared based on the presence or absence of STB and severity of anxiety symptoms (minimal, mild, moderate, and severe). Univariate and multivariable logistic regressions were conducted to examine the correlations of STB, considering multicollinearity. RESULTS Patients with mild, moderate, and severe anxiety symptoms had higher odds of STB than those with minimal symptoms. Gender, marital status, age, and depressive symptoms were other strong predictors of STB. There was no difference in the odds of STB between patients with major depressive disorder (MDD) and those with bipolar disorders (BD). However, the odds of suicidal ideation were slightly lower among patients with BD than those with MDD. LIMITATIONS Our sample was comprised only of outpatients, limiting the generalization of our findings. Other limitations include the lack of structured interviews for diagnostic characterization of the patients and the utilization of data on anxiety and mood obtained solely through self-report scales. CONCLUSIONS We found a cross-sectional association between the severity of anxiety symptoms and STB among patients with mood disorders. This study demonstrates the need for a suicide risk assessment in patients with mood disorders reporting anxiety symptoms.
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Affiliation(s)
- Marsal Sanches
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA.
| | - Linh K Nguyen
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tong Han Chung
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - William H Coryell
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jair C Soares
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
| | - Sudhakar Selvaraj
- UT Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, UT Health McGovern Medical School, Houston, TX, USA
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22
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Wang H, Zhu R, Tian S, Zhang S, Dai Z, Shao J, Xue L, Yao Z, Lu Q. Dynamic connectivity alterations in anterior cingulate cortex associated with suicide attempts in bipolar disorders with a current major depressive episode. J Psychiatr Res 2022; 149:307-314. [PMID: 35325759 DOI: 10.1016/j.jpsychires.2022.03.010] [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: 08/06/2021] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Considering that the physiological mechanism of the anterior cingulate cortex (ACC) in suicide brain remains elusive for bipolar disorder (BD) patients. The study aims to investigate the intrinsic relevance between ACC and suicide attempts (SA) through transient functional connectivity (FC). METHODS We enrolled 50 un-medicated BD patients with at least one SA, 67 none-suicide attempt patients (NSA) and 75 healthy controls (HCs). The sliding window approach was utilized to study the dynamic FC of ACC via resting-state functional MRI data. Subsequently, we probed into the temporal properties of dynamic FC and then estimated the relationship between dynamic characteristics and clinical variables using the Pearson correlation. RESULTS We found six distinct FC states in all populations, with one of them being more associated with SA. Compared with NSA and HCs, the suicide-related functional state showed significantly reduced dwell time in SA patients, accompanied by a significantly increased FC strength between the right ACC and the regions within the subcortical (SubC) network. In addition, the number of transitions was significantly increased in SA patients relative to other groups. All these altered indicators were significantly correlated with the suicide risk. CONCLUSIONS The results suggested that the dysfunction of ACC was relevant to SA from a dynamic FC perspective in BD patients. It highlights the temporal properties in dynamic FC of ACC that could be used as a putative target of suicide risk assessment for BD patients.
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Affiliation(s)
- Huan Wang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Rongxin Zhu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Shui Tian
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Siqi Zhang
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Zhongpeng Dai
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Junneng Shao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Li Xue
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China
| | - Zhijian Yao
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China; Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China.
| | - Qing Lu
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China; Child Development and Learning Science, Key Laboratory of Ministry of Education, China.
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Directly or Indirectly? The Role of Social Support in the Psychological Pathways Underlying Suicidal Ideation in People with Bipolar Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095286. [PMID: 35564679 PMCID: PMC9099991 DOI: 10.3390/ijerph19095286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
Contemporary theories of suicide, such as the Schematic Appraisals Model (SAMS), hypothesize that negative perceptions of social support are implicated in the pathways to suicidal experiences. The SAMS predicts that perceived social support influences suicidal ideation through appraisals of defeat and entrapment. However, such pathways have not been investigated in people who have bipolar disorder. This prospective four-month study tested the influence of perceived social support on later suicidal ideation via changes in defeat, entrapment, and hopelessness, in a sample of eighty euthymic participants with bipolar disorder (N = 62 at follow-up). Linear regression models tested the extent to which perceived social support at baseline predicted changes in suicidal ideation at four months directly and indirectly via changes in defeat, entrapment, and hopelessness. Perceived social support did not directly predict changes in suicidal ideation, but there was a significant indirect mediational pathway between perceived social support at baseline and changes in suicidal ideation over time, via changes in defeat, entrapment and hopelessness, supporting the SAMS. Psychological interventions which target negative perceptions of social support early, in tandem with addressing defeat, entrapment, and hopelessness over time, present a potentially effective approach to counter suicidal ideation in people who experience bipolar disorder.
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Lee D, Baek JH, Ha K, Cho EY, Choi Y, Yang SY, Kim JS, Cho Y, Won HH, Hong KS. Dissecting the genetic architecture of suicide attempt and repeated attempts in Korean patients with bipolar disorder using polygenic risk scores. Int J Bipolar Disord 2022; 10:3. [PMID: 35112160 PMCID: PMC8811109 DOI: 10.1186/s40345-022-00251-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) has the greatest suicide risk among mental and physical disorders. A recent genome-wide association study (GWAS) of European ancestry (EUR) samples revealed that the genetic etiology of suicide attempt (SA) was not only polygenic but also, in part, diagnosis-specific. The authors aimed to examine whether the polygenic risk score (PRS) for SA derived from that study is associated with SA or repeated attempts in Korean patients with BD. This study also investigated the shared heritability of SA and mental disorders which showed an increased risk of SA and a high genetic correlation with BD. METHODS The study participants were 383 patients with BD. The history of SA was assessed on a lifetime basis. PRSs for reference disorders were calculated using the aforementioned GWAS data for SA and the Psychiatric Genomics Consortium data of BD, schizophrenia, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). RESULTS The PRS for SA was significantly associated with lifetime SA in the current subjects (Nagelkerke's R2 = 2.73%, odds ratio [OR] = 1.36, p = 0.007). Among other PRSs, only the PRS for OCD was significantly associated with lifetime SA (Nagelkerke's R2 = 2.72%, OR = 1.36, p = 0.007). The PRS for OCD was higher in multiple attempters than in single attempters (Nagelkerke's R2 = 4.91%, OR = 1.53, p = 0.043). CONCLUSION The PRS for SA derived from EUR data was generalized to SA in Korean patients with BD. The PRS for OCD seemed to affect repeated attempts. Genetic studies on suicide could benefit from focusing on specific psychiatric diagnoses and refined sub-phenotypes, as well as from utilizing multiple PRSs for related disorders.
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Affiliation(s)
- Dongbin Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Kyooseob Ha
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
- Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun-Young Cho
- Samsung Biomedical Research Institute, Seoul, South Korea
| | - Yujin Choi
- Samsung Biomedical Research Institute, Seoul, South Korea
| | - So-Yung Yang
- Department of Psychiatry, NHIS Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Ji Sun Kim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Yunji Cho
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hong-Hee Won
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, South Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
- Samsung Biomedical Research Institute, Seoul, South Korea.
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Av Kák Kollsker S, Coello K, Stanislaus S, Melbye S, Lie Kjaerstad H, Stefanie Ormstrup Sletved K, Vedel Kessing L, Vinberg M. Association between lifetime and recent stressful life events and the early course and psychopathology in patients with newly diagnosed bipolar disorder, first-degree unaffected relatives and healthy controls: Cross-sectional results from a prospective study. Bipolar Disord 2022; 24:59-68. [PMID: 33938103 DOI: 10.1111/bdi.13093] [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: 11/29/2022]
Abstract
OBJECTIVE There is an accumulation of stressful life events prior to the first mood episode, but the impact of previous severe life events on psychopathology in patients with bipolar disorder (BD) is not well studied. We aimed to examine the number of recent and lifetime life events in patients with newly diagnosed BD, their unaffected relatives (UR), and healthy controls (HC) as well as the impact of severe lifetime life events on the early course of BD. METHODS We compared the number of recent and lifetime life events in 398 patients with newly diagnosed BD, 109 UR, and 214 HC. We subsequently dichotomized the patients with BD by >2 lifetime life events to investigate the associations of severe lifetime life events with clinical characteristics and affective symptoms. RESULTS Patients with newly diagnosed BD reported significantly more life events in the last 12 months and lifetime before compared with UR and HC. Patients who reported >2 lifetime life events (n = 160) compared with patients with 0-2 life events (n = 238) had a significantly longer diagnostic delay (9.5 years ± 8.2 vs. 6.2 years ± 6.9), presented with more anxiety and depressive symptoms and had at least one previous suicide attempt (30.6% vs. 15.6%) and one previous admission (51.3% vs. 36.6%). CONCLUSION The experience of severe lifetime life events seems to impact the early course in BD in terms of longer diagnostic delay, more severe psychopathology including more admissions and a more than doubled risk for previous suicide attempts.
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Affiliation(s)
- Stina Av Kák Kollsker
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark
| | - Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark
| | - Sharleny Stanislaus
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark
| | - Sigurd Melbye
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark
| | - Hanne Lie Kjaerstad
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark
| | | | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC, Psychiatric Centre Copenhagen, Rigshospitalet, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
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26
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Malhi GS, Bell E, Mannie Z. Preventing suicide by young people requires integrative strategies. Med J Aust 2021; 216:54. [PMID: 34877690 DOI: 10.5694/mja2.51367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 02/01/2023]
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Lalovic A, Wang S, Keilp JG, Bowie CR, Kennedy SH, Rizvi SJ. A qualitative systematic review of neurocognition in suicide ideators and attempters: Implications for cognitive-based psychotherapeutic interventions. Neurosci Biobehav Rev 2021; 132:92-109. [PMID: 34774586 DOI: 10.1016/j.neubiorev.2021.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Growing evidence suggests cognitive deficits may represent neurocognitive markers with predictive utility in identifying those at risk for suicide. Characterizing these deficits may offer the opportunity to develop targeted interventions. AIM The aim of this systematic qualitative review is to provide a synthesis of the published data on neurocognition in suicide ideators and attempters in order to clarify which neurocognitive targets may be most relevant to address using cognitive-based psychotherapeutic strategies in patients at risk for suicide. RESULTS A total of 63 studies met criteria for inclusion. The most consistent findings were in depressed suicide attempters, where deficits in executive subdomains of inhibition, selective attention and decision-making, as well as in working memory, were identified. In contrast, no clear pattern of neurocognitive deficits emerged from studies in suicide ideators across diagnoses. CONCLUSIONS More studies are needed to clarify the role of cognitive deficits in specific subtypes of individuals at risk for suicide. The findings are discussed in the context of promising research on cognitive remediation and other psychological interventions.
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Affiliation(s)
- Aleksandra Lalovic
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shijing Wang
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - John G Keilp
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Christopher R Bowie
- Department of Psychology, Queen's University, Kingston, Ontario, Canada; Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Sakina J Rizvi
- ASR Suicide and Depression Studies Program, Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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28
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Kessing LV, Ziersen SC, Andersen PK, Vinberg M. A nation-wide population-based longitudinal study on life expectancy and cause specific mortality in patients with bipolar disorder and their siblings. J Affect Disord 2021; 294:472-476. [PMID: 34325167 DOI: 10.1016/j.jad.2021.07.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Mortality is increased in bipolar disorder due to both suicide and death by physical disorders, but it has never been investigated whether these mortalities translate into relatives to patients with bipolar disorder. The aim was to present the life expectancy and the overall mortality and mortality due to suicide and physical disorders among patients with bipolar disorder and their unaffected full siblings, respectively, compared with control individuals from the general population. METHODS We used Danish nation-wide population-based longitudinal register linkage to identify 19.955 patients with bipolar disorder, their 13.923 siblings and 20 sex, age and calendar matched control individuals from the general population. Follow-up was from 1995 to 2017. RESULTS Bipolar disorder was associated with a decreased life expectancy of 7.7 (95% CI: 7.4-8.1) years and increased mortality overall (hazard ratio (HR): 2.11 (95% CI: 2.04-2.18)) and due to suicide (HR: 18.23 (95% CI: 15.81-21.02) and physical disorders (HR: 2.01 (95% CI: 1.94-2.08). In contrast, siblings to patients with bipolar disorder who were unaffected by bipolar disorder did not have decreased life expectancy (0.45 (95% CI: -6.62-2.46)) or increased mortality overall (HR: 1.00 (95% CI: 0.88-1.14) or due to suicide (HR: 1.50 (95% CI: 0.95-2.36) or physical disorders (HR: 0.99 (95% CI: 0.87-1.34). CONCLUSIONS Increased mortality in bipolar disorder is mainly due to the impact of bipolar psychopathology and to a lesser degree to familial transmitted factors, highlighting the urgent need for preventive intervention studies in relation to suicide and physical disorders following onset of bipolar disorder.
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Affiliation(s)
- Lars Vedel Kessing
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen; University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark.
| | - Simon Christoffer Ziersen
- University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark; Department of Biostatistics, University of Copenhagen, Denmark
| | - Per Kragh Andersen
- University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark; Department of Biostatistics, University of Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen Affective disorder Research Center (CADIC), Psychiatric Center Copenhagen; University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød, Denmark
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29
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Dean RL, Marquardt T, Hurducas C, Spyridi S, Barnes A, Smith R, Cowen PJ, McShane R, Hawton K, Malhi GS, Geddes J, Cipriani A. Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder. Cochrane Database Syst Rev 2021; 10:CD011611. [PMID: 34623633 PMCID: PMC8499740 DOI: 10.1002/14651858.cd011611.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Glutamergic system dysfunction has been implicated in the pathophysiology of bipolar depression. This is an update of the 2015 Cochrane Review for the use of glutamate receptor modulators for depression in bipolar disorder. OBJECTIVES 1. To assess the effects of ketamine and other glutamate receptor modulators in alleviating the acute symptoms of depression in people with bipolar disorder. 2. To review the acceptability of ketamine and other glutamate receptor modulators in people with bipolar disorder who are experiencing depressive symptoms. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase and PsycINFO all years to July 2020. We did not apply any restrictions to date, language or publication status. SELECTION CRITERIA RCTs comparing ketamine or other glutamate receptor modulators with other active psychotropic drugs or saline placebo in adults with bipolar depression. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. Primary outcomes were response rate and adverse events. Secondary outcomes included remission rate, depression severity change scores, suicidality, cognition, quality of life, and dropout rate. The GRADE framework was used to assess the certainty of the evidence. MAIN RESULTS Ten studies (647 participants) were included in this review (an additional five studies compared to the 2015 review). There were no additional studies added to the comparisons identified in the 2015 Cochrane review on ketamine, memantine and cytidine versus placebo. However, three new comparisons were found: ketamine versus midazolam, N-acetylcysteine versus placebo, and riluzole versus placebo. The glutamate receptor modulators studied were ketamine (three trials), memantine (two), cytidine (one), N-acetylcysteine (three), and riluzole (one). Eight of these studies were placebo-controlled and two-armed. In seven trials the glutamate receptor modulators had been used as add-on drugs to mood stabilisers. Only one trial compared ketamine with an active comparator, midazolam. The treatment period ranged from a single intravenous administration (all ketamine studies), to repeated administration for riluzole, memantine, cytidine, and N-acetylcysteine (with a follow-up of eight weeks, 8 to 12 weeks, 12 weeks, and 16 to 20 weeks, respectively). Six of the studies included sites in the USA, one in Taiwan, one in Denmark, one in Australia, and in one study the location was unclear. All participants had a primary diagnosis of bipolar disorder and were experiencing an acute bipolar depressive episode, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (IV) or fourth edition text revision (IV-TR). Among all glutamate receptor modulators included in this review, only ketamine appeared to be more efficacious than placebo 24 hours after infusion for response rate (odds ratio (OR) 11.61, 95% confidence interval (CI) 1.25 to 107.74; P = 0.03; participants = 33; studies = 2; I² = 0%, low-certainty evidence). Ketamine seemed to be more effective in reducing depression rating scale scores (MD -11.81, 95% CI -20.01 to -3.61; P = 0.005; participants = 32; studies = 2; I2 = 0%, very low-certainty evidence). There was no evidence of ketamine's efficacy in producing remission over placebo at 24 hours (OR 5.16, 95% CI 0.51 to 52.30; P = 0.72; participants = 33; studies = 2; I2 = 0%, very low-certainty evidence). Evidence on response, remission or depression rating scale scores between ketamine and midazolam was uncertain at 24 hours due to very low-certainty evidence (OR 3.20, 95% CI 0.23 to 45.19). In the one trial assessing ketamine and midazolam, there were no dropouts due to adverse effects or for any reason (very low-certainty evidence). Placebo may have been more effective than N-acetylcysteine in reducing depression rating scale scores at three months, although this was based on very low-certainty evidence (MD 1.28, 95% CI 0.24 to 2.31; participants = 58; studies = 2). Very uncertain evidence found no difference in response at three months (OR 0.82, 95% CI 0.32 to 2.14; participants = 69; studies = 2; very low-certainty evidence). No data were available for remission or acceptability. Extremely limited data were available for riluzole vs placebo, finding only very-low certainty evidence of no difference in dropout rates (OR 2.00, 95% CI 0.31 to 12.84; P = 0.46; participants = 19; studies = 1; I2 = 0%). AUTHORS' CONCLUSIONS It is difficult to draw reliable conclusions from this review due to the certainty of the evidence being low to very low, and the relatively small amount of data usable for analysis in bipolar disorder, which is considerably less than the information available for unipolar depression. Nevertheless, we found uncertain evidence in favour of a single intravenous dose of ketamine (as add-on therapy to mood stabilisers) over placebo in terms of response rate up to 24 hours, however ketamine did not show any better efficacy for remission in bipolar depression. Even though ketamine has the potential to have a rapid and transient antidepressant effect, the efficacy of a single intravenous dose may be limited. We did not find conclusive evidence on adverse events with ketamine, and there was insufficient evidence to draw meaningful conclusions for the remaining glutamate receptor modulators. However, ketamine's psychotomimetic effects (such as delusions or delirium) may have compromised study blinding in some studies, and so we cannot rule out the potential bias introduced by inadequate blinding procedures. To draw more robust conclusions, further methodologically sound RCTs (with adequate blinding) are needed to explore different modes of administration of ketamine, and to study different methods of sustaining antidepressant response, such as repeated administrations.
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Affiliation(s)
| | | | | | - Styliani Spyridi
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Lemesos, Cyprus
| | | | | | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rupert McShane
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Keith Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Gin S Malhi
- Discipline of Psychiatry, Northern Clinical School, University of Sydney, Sydney, Australia
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30
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Abnormal within- and cross-networks functional connectivity in different outcomes of herpes zoster patients. Brain Imaging Behav 2021; 16:366-378. [PMID: 34549378 DOI: 10.1007/s11682-021-00510-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 12/23/2022]
Abstract
Neuroimaging studies have displayed aberrant brain activities in individual sensory- and emotional-linked regions in postherpetic neuralgia (PHN) patients. However, multi-dimensional dysfunction in chronic pain may rely on the interplay between networks. Little is known about the changes in the functional architecture of resting state networks (RSNs) in PHN. In this cross-sectional study, we recruited 31 PHN patients, 33 RHZ patients and 34 HCs; all participants underwent resting-state functional magnetic resonance imaging scans. We investigated the differences of within- and cross-network connectivities between different outcomes of HZ patients [including PHN and recuperation from herpes zoster (RHZ)] and healthy controls (HCs) so as to extract a characteristic network pattern of PHN. The abnormal network connectivities were then correlated with clinical variables in respective groups. PHN and RHZ patients could be similarly characterized by abnormal within-default mode network (DMN), DMN-salience network (SN) and SN-basal ganglia network (BGN) connectivity relative to HCs. Of note, compared with RHZ patients, PHN patients could be characterized by abnormal DMN-BGN and within-BGN connectivity. Furthermore, the within-DMN connectivity was associated with pain-induced emotional scores among PHN patients. Our study presented that network-level imbalance could account for the pain-related dysfunctions in different outcomes of herpes zoster patients. These insights are potentially useful for understanding neuromechanism of PHN and providing central therapeutic targets for PHN.
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Cheng X, Chen J, Zhang X, Zhang Y, Wu Q, Ma Q, Sun J, Zou W, Lin T, Zhong L, Deng W, Sun X, Cui L, Cheng X, Chen Y, Cai Y, Zheng C, Cheng D, Yang C, Ye B, Zhang X, Wei X, Cao L. Alterations in resting-state global brain connectivity in bipolar I disorder patients with prior suicide attempt. Bipolar Disord 2021; 23:474-486. [PMID: 32981096 DOI: 10.1111/bdi.13012] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bipolar I disorder (BD-I) is associated with a high risk of suicide attempt; however, the neural circuit dysfunction that confers suicidal vulnerability in individuals with this disorder remains largely unknown. Resting-state functional magnetic resonance imaging (rs-fMRI) allows non-invasive mapping of brain functional connectivity. The current study used an unbiased voxel-based graph theory analysis of rs-fMRI to investigate the intrinsic brain networks of BD-I patients with and without suicide attempt. METHODS A total of 30 BD-I patients with suicide attempt (attempter group), 82 patients without suicide attempt (non-attempter group), and 67 healthy controls underwent rs-fMRI scan, and then global brain connectivity (GBC) was computed as the sum of connections of each voxel with all other gray matter voxels in the brain. RESULTS Compared with the non-attempter group, we found regional differences in GBC values in emotion-encoding circuits, including the left superior temporal gyrus, bilateral insula/rolandic operculum, and right precuneus (PCu)/cuneus in the bipolar disorder (BD) attempter group, and these disrupted hub-like regions displayed fair to good power in distinguishing attempters from non-attempters among BD-I patients. GBC values of the right PCu/cuneus were positively correlated with illness duration and education in the attempter group. CONCLUSIONS Our results indicate that abnormal connectivity patterns in emotion-encoding circuits are associated with the increasing risk of vulnerability to suicide attempt in BD patients, and global dysconnectivity across these emotion-encoding circuits might serve as potential biomarkers for classification of suicide attempt in BD patients.
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Affiliation(s)
- Xiaofang Cheng
- The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, PR China.,The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Jianshan Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Xiaofei Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Yihe Zhang
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, PR China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, PR China.,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, PR China
| | - Qiuxia Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Qing Ma
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, PR China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, PR China.,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, PR China
| | - Jiaqi Sun
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Wenjin Zou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Taifeng Lin
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Liangda Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Wenhao Deng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Xiaoyi Sun
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, PR China.,Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, PR China.,IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, PR China
| | - Liqian Cui
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | | | - Yingmei Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Yinglian Cai
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Chaodun Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Daomeng Cheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Chanjuan Yang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Biyu Ye
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
| | - Xiangyang Zhang
- Department of Radiology, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China
| | - Xinhua Wei
- Jinan University, Guangzhou, Guangdong, PR China.,Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, PR China
| | - Liping Cao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, PR China
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Sewall CJ, Girard JM, Merranko J, Hafeman D, Goldstein BI, Strober M, Hower H, Weinstock LM, Yen S, Ryan ND, Keller MB, Liao F, Diler RS, Gill MK, Axelson D, Birmaher B, Goldstein TR. A Bayesian multilevel analysis of the longitudinal associations between relationship quality and suicidal ideation and attempts among youth with bipolar disorder. J Child Psychol Psychiatry 2021; 62:905-915. [PMID: 33107600 PMCID: PMC8628509 DOI: 10.1111/jcpp.13343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/20/2020] [Accepted: 10/07/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Youth with bipolar disorder (BD) are at high risk for suicidal thoughts and behaviors and frequently experience interpersonal impairment, which is a risk factor for suicide. Yet, no study to date has examined the longitudinal associations between relationship quality in family/peer domains and suicidal thoughts and behaviors among youth with BD. Thus, we investigated how between-person differences - reflecting the average relationship quality across time - and within-person changes, reflecting recent fluctuations in relationship quality, act as distal and/or proximal risk factors for suicidal ideation (SI) and suicide attempts. METHODS We used longitudinal data from the Course and Outcome of Bipolar Youth Study (N = 413). Relationship quality variables were decomposed into stable (i.e., average) and varying (i.e., recent) components and entered, along with major clinical covariates, into separate Bayesian multilevel models predicting SI and suicide attempt. We also examined how the relationship quality effects interacted with age and sex. RESULTS Poorer average relationship quality with parents (β = -.33, 95% Bayesian highest density interval (HDI) [-0.54, -0.11]) or friends (β = -.33, 95% HDI [-0.55, -0.11]) was longitudinally associated with increased risk of SI but not suicide attempt. Worsening recent relationship quality with parents (β = -.10, 95% HDI [-0.19, -0.03]) and, to a lesser extent, friends (β = -.06, 95% HDI [-0.15, 0.03]) was longitudinally associated with increased risk of SI, but only worsening recent relationship quality with parents was also associated with increased risk of suicide attempt (β = -.15, 95% HDI [-0.31, 0.01]). The effects of certain relationship quality variables were moderated by gender but not age. CONCLUSIONS Among youth with BD, having poorer average relationship quality with peers and/or parents represents a distal risk factor for SI but not suicide attempts. Additionally, worsening recent relationship quality with parents may be a time-sensitive indicator of increased risk for SI or suicide attempt.
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Affiliation(s)
| | | | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - Benjamin I. Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University,Department of Health Services, Policy, and Practice, Brown University School of Public Health
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - Martin B. Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - Rasim S. Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - David Axelson
- Department of Psychiatry, Nationwide Children’s Hospital and The Ohio State College of Medicine
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine
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Kato T. Moderation Effects of Coping Flexibility on the Association Between Depressive Symptoms and Suicidal Risk. CRISIS 2021; 43:398-403. [PMID: 34128687 DOI: 10.1027/0227-5910/a000800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: This study focused on poor coping flexibility, which involves the perseveration of a failed coping strategy, as a moderator of the association between depression and suicidal risk; no study has previously examined the association between coping flexibility and suicidal risk. Aims: This study examined whether individuals with lower coping flexibility would have a stronger suicidal risk when experiencing depression above a certain level. Method: Participants, who were 682 college students, answered questionnaires regarding coping flexibility, depressive symptoms, and suicidal risk. Results: Hierarchical multiple regression analyses showed that in individuals with greater depressive symptoms, lower coping flexibility was associated with higher suicidal risk, but this was not the case in individuals without depressive symptoms. Our hypothesis was supported. Limitations: Our findings cannot indicate the causal direction of the association between coping flexibility and depressive symptoms and suicidal risk. Conclusion: Our findings may be useful in understanding the association between depression and suicidal risk through coping flexibility and contribute to reductions in suicidal risk, as coping flexibility can be improved through training.
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Affiliation(s)
- Tsukasa Kato
- Department of Social Psychology, Tokyo University, Japan
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34
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Almeida VFD, Bezerra-Filho S, Studart-Bottó P, Léda-Rego G, Silva ITF, Kapczinski F, Miranda-Scippa Â. History of suicide attempts in patients with bipolar disorder type I: socio-demographic and clinical factors, quality of life and functioning. Nord J Psychiatry 2021; 75:306-313. [PMID: 33302763 DOI: 10.1080/08039488.2020.1853230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aims to evaluate sociodemographic and clinical factors, quality of life (QoL) and functioning associated with history of suicide attempts (SA) in a sample of bipolar disorder (BD) type I patients. METHODS A total of 417 BD type I patients, with and without history of SA were recruited from two Brazilian specialized Mood Disorder Centers. They were assessed with a sociodemographic and clinical questionnaire, the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Structured Clinical Interviews for DSM-IV Axis I Disorders, the World Health Organization Quality of Life-BREF, and the Sheehan Disability Scale. RESULTS One hundred and seventy-nine (42.9%) patients had a history of SA. There were no statistically significant sociodemographic differences between BD patients with and without a history of SA. Logistic regression found that lifetime hospitalization, comorbid anxiety disorders, depressive polarity in the first episode, current intensity of depressive symptoms, history of rapid cycling, family history of suicide and age at onset were significantly associated with SA in BD. Multiple linear regression showed that SA had no effect on QoL and functioning, which were affected mainly by comorbid anxiety disorders and current intensity of depressive symptoms, even in patients considered euthymic. CONCLUSION Suicidal behavior in patients with BD is a complex phenomenon and reflects a more severe course of illness. Patients with history of SA may have worse QoL and functional impairment not because of its direct effect, but because of the greater association with clinical factors related to poor prognosis.
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Affiliation(s)
| | | | - Paula Studart-Bottó
- Mood and Anxiety Disorders Program (CETHA), UFBA, Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | - Gabriela Léda-Rego
- Mood and Anxiety Disorders Program (CETHA), UFBA, Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil
| | | | - Flávio Kapczinski
- Mood Disorders Program, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Ângela Miranda-Scippa
- Mood and Anxiety Disorders Program (CETHA), UFBA, Salvador, Brazil.,Postgraduate Program in Medicine and Health, UFBA, Salvador, Brazil.,Department of Neurosciences and Mental Health, Bahia Medical School, UFBA, Salvador, Brazil
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Nobile B, Dubois J, Aouizerate B, Aubin V, Loftus J, Bellivier F, Belzeaux R, Dubertret C, Gard S, Haffen E, Schwan R, Llorca PM, Passerieux C, Roux P, Polosan M, Etain B, Leboyer M, Courtet P, Olié E. Characterization of depressed bipolar patients with current suicidal ideation. Aust N Z J Psychiatry 2021; 55:289-304. [PMID: 33043675 DOI: 10.1177/0004867420963744] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30-50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up. METHODS Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery-Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline (N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology-Self Report (N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology-Self Report score <2 (N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years. RESULTS Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology). CONCLUSIONS Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.
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Affiliation(s)
- Bénédicte Nobile
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France and PSNREC, University of Montpellier, INSERM, CHU of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Jonathan Dubois
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France and PSNREC, University of Montpellier, INSERM, CHU of Montpellier, Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Charles-Perrens Hospital, Department of clinical and academic Psychiatry, Bordeaux.,France/NutriNeuro, UMR INRA 1286, University of Bordeaux, Bordeaux, France
| | - Valerie Aubin
- Psychiatric Center, Hospital Princess Grace, Monaco, France
| | - Joséphine Loftus
- Fondation FondaMental, Créteil, France.,Psychiatric Center, Hospital Princess Grace, Monaco, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France.,AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Fernand Widal, and INSERM UMRS 1144 and Université de Paris, Paris, France
| | - Raoul Belzeaux
- Fondation FondaMental, Créteil, France.,Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université, Marseille, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, DMU ESPRIT, service de Psychiatrie et Addictologie. Hopital Louis Mourier, Colombes, Inserm U1266, Faculté de médecine, Université de Paris, France
| | - Sebastien Gard
- Fondation FondaMental, Créteil, France.,Charles-Perrens Hospital, Department of clinical and academic Psychiatry, Bordeaux
| | - Emmanuel Haffen
- Fondation FondaMental, Créteil, France.,Service de Psychiatrie de l'Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université de Franche-Comté, UBFC
| | - Raymund Schwan
- Fondation FondaMental, Créteil, France.,Université de Lorraine; Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Nancy, France; INSERM U1114
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, EA 7280, Clermont-Ferrand, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France and Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe "PsyDev", 94807, Villejuif, France
| | - Paul Roux
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France and Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe "PsyDev", 94807, Villejuif, France
| | - Mircea Polosan
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service de psychiatrie et d'addictologie adulte, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin-en-Yvelines, Versailles, France and Université Paris-Saclay, UVSQ, Inserm, CESP, Equipe "PsyDev", 94807, Villejuif, France
| | - Bruno Etain
- Fondation FondaMental, Créteil, France.,AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Fernand Widal, and INSERM UMRS 1144 and Université de Paris, Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,AP-HP, Département Médico-universitaire de Psychiatrie et d'addictologie (DMU ADAPT), Hôpitaux Universitaires Henri Mondor, Université Paris-est-Créteil, INSERM U955, équipe de Neuro-psychiatrie translationnelle, IMRB (Institut Mondor de Recherches Biomédicales), Créteil, France
| | | | - Philippe Courtet
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France and PSNREC, University of Montpellier, INSERM, CHU of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
| | - Emilie Olié
- Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, France and PSNREC, University of Montpellier, INSERM, CHU of Montpellier, Montpellier, France.,Fondation FondaMental, Créteil, France
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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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Comparisons between suicide in persons with serious mental illness, other mental disorders, or no known mental illness: Results from 37 U.S. states, 2003-2017. Schizophr Res 2021; 228:74-82. [PMID: 33434737 PMCID: PMC7987877 DOI: 10.1016/j.schres.2020.11.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/18/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide is a leading cause of death in persons with schizophrenia and other serious mental illnesses (SMI), however, little is known about the characteristics and circumstances of suicide decedents with SMI in the US compared to those with other or no known mental illness. METHODS This study was a retrospective analysis of suicide deaths in individuals aged ≥18 years from the National Violent Death Reporting System, 2003-2017. Odds ratios compared sociodemographic and clinical characteristics, cause of death, precipitating circumstances, and post-mortem toxicology results. All analyses were stratified by gender. RESULTS Of the 174,001 suicide decedents, 8.7% had a known SMI, 33.0% had other mental disorders, and 58.2% had no known mental illness. Relative to persons with other mental disorders, SMI decedents were younger and more likely to have previous suicide attempts and co-occurring drug use. Problems with intimate partners, poor physical health, and recent institutional release were the most common precipitating circumstances for SMI decedents. Firearms were the most common suicide method for males with SMI. Although 67.0% male and 76.0% of female SMI decedents were currently in treatment, toxicology results suggest many were not taking antipsychotic or antidepressant medications at the time of death. CONCLUSIONS Persons with SMI are over-represented in suicide deaths. Efforts to improve treatment of co-occurring substance use disorders, continuity of care following hospitalization, medication adherence, and to reduce access to firearms are important suicide prevention strategies.
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38
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Gong J, Chen G, Zhou M, Jia Y, Zhong S, Chen F, Lai S, Luo Z, Wang J, Xu H, Wang L, Huang L, Wang Y. Characteristics of temporal dynamics of intrinsic brain activity in unmedicated bipolar disorder with suicidality. Aust N Z J Psychiatry 2020; 54:1115-1124. [PMID: 32815392 DOI: 10.1177/0004867420948960] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bipolar disorder is associated with a high risk of suicide. Routine neuroimaging examination exhibited that bipolar disorder with suicidality was associated with brain structural and functional changes. However, the alterations of brain dynamics have still remained elusive. PURPOSE To investigate the alterations of brain dynamics in unmedicated bipolar disorder II depression with suicidality and predict the severity of suicidality. MATERIALS AND METHODS This prospective study included 106 bipolar disorder II participants (20 with suicidal attempt, 35 with suicidal ideation, 51 without suicidal ideation) and 50 healthy controls who underwent resting-state functional magnetic resonance imaging between February 2016 and December 2017. We first used sliding window analysis to evaluate the dynamic amplitude of low-frequency fluctuations. Then, we predicted the severity of suicidality using a multivariate regression model. RESULTS One-way analysis of covariance revealed that the dynamic amplitude of low-frequency fluctuations in the right temporal pole, inferior temporal gyrus, superior temporal gyrus and the bilateral precuneus/posterior cingulate cortex was significantly different among the four groups. Post hoc pairwise comparisons revealed that dynamic amplitude of low-frequency fluctuations was remarkably decreased in the bilateral precuneus/posterior cingulate cortex in the three bipolar disorder II groups compared with that in healthy controls group. Increased dynamic amplitude of low-frequency fluctuations was found in the right superior temporal gyrus and inferior temporal gyrus in the suicidal attempt group compared with that in the other groups, and in the right temporal pole in the suicidal attempt group compared with that in the suicidal ideation and healthy controls groups. Importantly, these temporal variabilities could be used to predict the severity of suicidality (r = 0.330, p = 0.036), whereas static amplitude of low-frequency fluctuations couldn't (r = -0.050, p = 0.532). CONCLUSION Our findings indicated that alterations of temporal variability in the precuneus/posterior cingulate cortex are such a common feature of bipolar disorder patients. Besides, the severity of suicidality could be predicted by the dynamic amplitude of low-frequency fluctuations abnormalities rather than static amplitude of low-frequency fluctuations abnormalities, which is the first evidence of dynamic brain alterations in bipolar disorder patients with suicidality. The proposed predictive model may be advantageous for clinical applications.
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Affiliation(s)
- Jiaying Gong
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mengyao Zhou
- Clinical Experimental Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhenye Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jurong Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hao Xu
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lu Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Institute of Molecular and Functional Imaging, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China.,Clinical Experimental Center, First Affiliated Hospital of Jinan University, Guangzhou, China
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Li H, Cui L, Cao L, Zhang Y, Liu Y, Deng W, Zhou W. Identification of bipolar disorder using a combination of multimodality magnetic resonance imaging and machine learning techniques. BMC Psychiatry 2020; 20:488. [PMID: 33023515 PMCID: PMC7542439 DOI: 10.1186/s12888-020-02886-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bipolar disorder (BPD) is a common mood disorder that is often goes misdiagnosed or undiagnosed. Recently, machine learning techniques have been combined with neuroimaging methods to aid in the diagnosis of BPD. However, most studies have focused on the construction of classifiers based on single-modality MRI. Hence, in this study, we aimed to construct a support vector machine (SVM) model using a combination of structural and functional MRI, which could be used to accurately identify patients with BPD. METHODS In total, 44 patients with BPD and 36 healthy controls were enrolled in the study. Clinical evaluation and MRI scans were performed for each subject. Next, image pre-processing, VBM and ReHo analyses were performed. The ReHo values of each subject in the clusters showing significant differences were extracted. Further, LASSO approach was recruited to screen features. Based on selected features, the SVM model was established, and discriminant analysis was performed. RESULTS After using the two-sample t-test with multiple comparisons, a total of 8 clusters were extracted from the data (VBM = 6; ReHo = 2). Next, we used both VBM and ReHo data to construct the new SVM classifier, which could effectively identify patients with BPD at an accuracy of 87.5% (95%CI: 72.5-95.3%), sensitivity of 86.4% (95%CI: 64.0-96.4%), and specificity of 88.9% (95%CI: 63.9-98.0%) in the test data (p = 0.0022). CONCLUSIONS A combination of structural and functional MRI can be of added value in the construction of SVM classifiers to aid in the accurate identification of BPD in the clinic.
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Affiliation(s)
- Hao Li
- grid.412615.5Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China ,grid.484195.5Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080 China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. .,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
| | - Liping Cao
- Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong, China.
| | - Yizhi Zhang
- grid.452505.30000 0004 1757 6882Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong China
| | - Yueheng Liu
- grid.216417.70000 0001 0379 7164Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan China ,Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan China
| | - Wenhao Deng
- grid.452505.30000 0004 1757 6882Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong China
| | - Wenjin Zhou
- grid.452505.30000 0004 1757 6882Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, Guangdong China
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40
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Aberrant functional connectivity and graph properties in bipolar II disorder with suicide attempts. J Affect Disord 2020; 275:202-209. [PMID: 32734909 DOI: 10.1016/j.jad.2020.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/10/2020] [Accepted: 07/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The physiological mechanism of suicide attempt (SA) in bipolar II disorder (BD-II) remains only partially understood. The study seeks to identify the dysfunction pattern in suicide brain for BD-II patients. METHODS Graph theory was utilized to explore topological properties at whole-brain, module and region levels based on resting-state functional MRI (rs-fMRI) data, which acquired from 38 un-medicated BD-II patients with at least one SA, 60 none SA (NSA) patients and 69 healthy controls (HCs). Finally, the correlation relationship between graph metrics and clinical variables were estimated. RESULTS Compared with NSA patients and HCs, the functional connectivity strength between limbic/sub-cortical (LIMB/SubC) and frontoparietal network (FPN) were significantly weakened. Nodal strength in left head of caudate nucleus (HCN), raphe nucleus (RN), right nucleus accumbens (NAcc), right subgenual anterior cingulate cortex (sgACC) and nodal efficiency in right sgACC, right HCN for SA patients were significantly reduced relative to NSA and HCs. In particular, nodal strength in RN and nodal efficiency in right sgACC showed a significant negative correlation with Nurses' Global Assessment of Suicide Risk (NGASR) scores. LIMITATIONS This is a single-mode cross-sectional study, the results were not verified by multi-center data. CONCLUSIONS The abnormal disrupted FC between LIMB/SubC and FPN is associated with SA in BD-II patients, which increased the susceptibility of suicide. Especially, the dysfunction in RN and right sgACC predict a higher suicide risk in BD-II patients.The results can help us to understand the suicide mechanism and early judgment of suicidal behaviors for BD-II patients.
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Wu Y, Wang C, Qian W, Yu L, Xing X, Wang L, Sun N, Zhang M, Yan M. Disrupted default mode network dynamics in recuperative patients of herpes zoster pain. CNS Neurosci Ther 2020; 26:1278-1287. [PMID: 32677342 PMCID: PMC7702236 DOI: 10.1111/cns.13433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Previous studies of herpes zoster (HZ) have focused on acute patient manifestations and the most common sequela, postherpetic neuralgia (PHN), both serving to disrupt brain dynamics. Although the majority of such patients gradually recover, without lingering severe pain, little is known about life situations of those who recuperate or the brain dynamics. Our goal was to determine whether default mode network (DMN) dynamics of the recuperative population normalize to the level of healthy individuals. Methods For this purpose, we conducted resting‐state functional magnetic resonance imaging (fMRI) studies in 30 patients recuperating from HZ (RHZ group) and 30 healthy controls (HC group). Independent component analysis (ICA) was initially undertaken in both groups to extract DMN components. DMN spatial maps and within‐DMN functional connectivity were then compared by group and then correlated with clinical variables. Results Relative to controls, DMN spatial maps of recuperating patients showed higher connectivity in middle frontal gyrus (MFG), right/left medial temporal regions of cortex (RMTC/LMTC), right parietal lobe, and parahippocampal gyrus. The RHZ (vs HC) group also demonstrated significant augmentation of within‐DMN connectivity, including that of LMTC‐MFG and LMTC‐posterior cingulate cortex (PCC). Furthermore, the intensity of LMTC‐MFG connectivity correlated significantly with scoring of pain‐induced emotions and life quality. Conclusion Findings of this preliminary study indicate that a disrupted dissociative pattern of DMN persists in patients recuperating from HZ, relative to healthy controls. We have thus provisionally established the brain mechanisms accounting for major outcomes of HZ, offering heuristic cues for future research on HZ transition states.
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Affiliation(s)
- Ying Wu
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Qian
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lina Yu
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiufang Xing
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lieju Wang
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Na Sun
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Yan
- Department of Anesthesiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Hopelessness is associated with repeated suicidal behaviors after discharge in patients admitted to emergency departments for attempted suicide. J Affect Disord 2020; 272:170-175. [PMID: 32379612 DOI: 10.1016/j.jad.2020.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/03/2020] [Accepted: 04/24/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hopelessness may be associated with an increased risk of suicide. However, findings regarding the long-term predictive ability of the Beck Hopelessness Scale (BHS) for suicide are inconsistent. This study investigated the long-term predictive ability of BHS scores for subsequent self-harm episodes in individuals admitted to an emergency department after attempting suicide. METHODS The BHS was administered to 805 adult patients with a DSM-IV-TR axis I disorder admitted to an emergency department following a suicide attempt. The patients were followed for at least 18 months and up to 5 years. The incidence of the first subsequent suicidal behavior (attempt or dying by suicide) was examined and the numbers per person-year of overall repeat self-harm episodes, suicide attempt episodes, and non-suicidal self-harm episodes were evaluated. RESULTS The total BHS scores showed significant associations with the overall number of self-harm episodes per person-year (incidence rate ratio [IRR], 1.05; 95% confidence interval [CI], 1.03-1.07; p < 0.0001), the number of suicide attempt episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.08; p < 0.0001), and the number of non-suicidal self-harm episodes per person-year (IRR, 1.05; 95%CI, 1.03-1.07; p < 0.0001). LIMITATIONS The study excluded children and adolescents. The sample size, while large, was insufficient to ensure generalizability, or to allow subanalyses based on specific disorders. CONCLUSIONS Hopelessness scores assessed in the emergency department after a self-harming episode were associated with a rate of repetition of suicidal behaviors after discharge. Additional strategies to address hopelessness of these patients are warranted.
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Ballard ED, Farmer CA, Shovestul B, Voort JV, Machado-Vieira R, Park L, Merikangas KR, Zarate CA. Symptom trajectories in the months before and after a suicide attempt in individuals with bipolar disorder: A STEP-BD study. Bipolar Disord 2020; 22:245-254. [PMID: 31737973 PMCID: PMC7289321 DOI: 10.1111/bdi.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The suicide crisis is a relatively short-lived psychiatric emergency, with transient symptoms that ebb and flow around the suicide attempt. Understanding the dynamic processes of symptoms before and after suicide attempt may aid future prevention efforts. METHODS Data were drawn from the NIMH STEP-BD study, which followed 4,360 patients with bipolar disorder; a subset attempted suicide during the trial (245/4100 or 5.97% of the sample eligible for analysis). This analysis focused on change in suicidal ideation (SI) in the 120 days before and 120 days after suicide attempt; similar analyses were conducted for other depressive symptoms. Generalized linear mixed models with a two-piece linear function of time corresponding to pre- and post-suicide attempt trends were used. RESULTS SI ratings from 216 individuals were analyzed (n = 1,231 total; n = 395 pre-attempt, n = 126 circa-attempt, n = 710 post-attempt) and compared to data from a matched sample of 648 non-attempters. SI worsened in the 120 days pre-attempt but improved afterwards, reaching non-attempter levels by 90 days post-attempt. A similar pattern was found for other depressive symptoms, including depressed mood, loss of interest, guilt, and self-esteem. Pre/post differences in tension/activating symptoms of depression-anxiety, agitation, and irritability-were less pronounced and more time-limited. CONCLUSIONS The suicide crisis is dynamic, and the days before and after suicide attempt may be particularly critical. The findings extend previous research on proximal symptoms of suicide and underscore that some SI and affective/cognitive symptoms of depression can remain elevated up to 90 days post-attempt in individuals with bipolar disorder.
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Affiliation(s)
- Elizabeth D. Ballard
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Cristan A. Farmer
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bridget Shovestul
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | - Rodrigo Machado-Vieira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Science Center, Houston, TX, USA
| | - Lawrence Park
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Carlos A. Zarate
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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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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Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Erica Bell
- Discipline of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Zola Mannie
- Discipline of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,NSW Health and Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW Australia
| | - Pritha Das
- Discipline of Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Academic Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
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Malhi GS. The Ethics of Suicide in Mental Illness: Novel Neuroscientific Perspectives. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:94-96. [PMID: 31566491 DOI: 10.1080/15265161.2019.1654021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Wada M, Kurose S, Miyazaki T, Nakajima S, Masuda F, Mimura Y, Nishida H, Ogyu K, Tsugawa S, Mashima Y, Plitman E, Chakravarty MM, Mimura M, Noda Y. The P300 event-related potential in bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2019; 256:234-249. [PMID: 31200163 DOI: 10.1016/j.jad.2019.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/21/2019] [Accepted: 06/03/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neurophysiology including P300, that is a typical index of event-related potential, may be potential biomarkers for bipolar disorder (BD) and it can be useful towards elucidating the pathophysiology of BD. However, previous findings from P300 studies were inconsistent due to the heterogeneity of research methods, which make it difficult to understand the neurobiological significance of them. The aim of this study is to conduct a meta-analysis on P300 in patients with BD. METHOD A literature search was conducted using PubMed to identify studies that compared P300 event-related potential between patients with BD and healthy controls (HCs). We analyzed P300 indices such as amplitude and latency of P3a and P3b in auditory or visual paradigms. Further, moderator analyses were conducted to investigate the influence of patient characteristics (i.e. history of psychosis, diagnostic subcategories [BD-I/BD-II], and phase of illness [euthymic, manic, or depressive]) on P300 indices. RESULT Out of 124 initial records, we included 30 articles (BD: N = 1331; HCs: N = 1818). Patients with BD showed reduced P3a and P3b amplitude in both paradigms and delayed P3b latency in auditory paradigms compared to HCs. There was no influence on the history of psychosis, diagnostic subcategories, or phase of illness on P300 indices. LIMITATION The difference in medication use was difficult to control and it may affect the results. CONCLUSION This meta-analysis provides evidence for P300 abnormalities in patients with BD compared to HCs. Our results suggest that P300 may be trait markers rather than state markers in this illness.
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Affiliation(s)
- Masataka Wada
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takahiro Miyazaki
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Fumi Masuda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yu Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hana Nishida
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kamiyu Ogyu
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Sakiko Tsugawa
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yuuki Mashima
- Center Hospital of the National Center for Global Health and Medicine, Japan
| | - Eric Plitman
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada; Department of Psychiatry, McGill University Biological and Biomedical Engineering, McGill University, Canada
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Yoshihiro Noda
- Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
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Icick R, Melle I, Etain B, Ringen PA, Aminoff SR, Leboyer M, Aas M, Henry C, Bjella TD, Andreassen OA, Bellivier F, Lagerberg TV. Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder. J Affect Disord 2019; 256:348-357. [PMID: 31202989 DOI: 10.1016/j.jad.2019.05.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/08/2019] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs - was independently associated with recurrent SA in BD. METHODS 916 patients from France and Norway with ascertained diagnoses of BD and reliable data about SA and SUD were classified as having no, single, or recurrent (≥2) SA. Five SUD groups were built according to the presence/absence/combination of tobacco, alcohol (AUD) and cannabis use disorders. Multinomial logistic regression was used to identify the correlates of SA recurrence. RESULTS 338 (37%) individuals reported at least one SA, half of whom (173, 51%) reported recurrence. SUD comorbidity was: tobacco smoking only, 397 (43%), tobacco smoking with at least another SUD, 179 (20%). Regression analysis showed that tobacco smoking, both alone and comorbid with AUD, depressive polarity of BD onset and female gender were independently associated with recurrent SA. LIMITATIONS Lack of data regarding the relative courses of SA and SUD and cross-national differences in main variables. CONCLUSION Tobacco smoking with- or without additional SUD can be important risk factors of SA recurrence in BD, which is likely to inform both research and prevention strategies.
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Affiliation(s)
- R Icick
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France.
| | - I Melle
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - B Etain
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - P A Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - S R Aminoff
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Leboyer
- FondaMental Foundation, Créteil F-94000, France; Inserm U955, Psychiatric Genetics Team, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Henri Mondor, DHU PePsy, Psychiatry Center, Créteil F-94000, France
| | - M Aas
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - C Henry
- FondaMental Foundation, Créteil F-94000, France; Paris Est University, Faculty of medicine, Créteil F-94000, France
| | - T D Bjella
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - F Bellivier
- Inserm, U1144, Paris F-75006, France; Paris Diderot University, UMR-S 1144, Paris F-75013, France; Assistance Publique - Hôpitaux de Paris, University Hospitals Saint-Louis - Lariboisière - F. Widal, Departement of Psychiatry and Addiction Medicine, Paris F-75010, France; FondaMental Foundation, Créteil F-94000, France
| | - T V Lagerberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Cannabis use disorder and suicide attempts in bipolar disorder: A meta-analysis. Neurosci Biobehav Rev 2019; 103:14-20. [DOI: 10.1016/j.neubiorev.2019.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/17/2019] [Accepted: 05/18/2019] [Indexed: 12/28/2022]
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Malhi G, Bell E, Das P, Outhred T. Relating irritability and suicidal ideation using mood and anxiety. EVIDENCE-BASED MENTAL HEALTH 2019; 22:95-99. [PMID: 31248975 PMCID: PMC10270456 DOI: 10.1136/ebmental-2019-300100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/17/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Suicide is common in the context of depression and bipolar disorders, but there remains a lack of understanding as to how suicide ideation, a common symptom of mood disorders, progresses to suicidal behaviour. Irritability, a feature of some types of depression, is thought to contribute to the development of suicidal behaviour, but these associations are not well established. OBJECTIVE To examine the relationship between irritability and suicide ideation according to the subtype of depression expressed in patients with mood disorder. METHODS 75 patients with mood disorders seen at the CADE (Clinical Assessment Diagnostic Evaluation) Clinic underwent clinical assessment for suicidal ideation (Paykel Suicide Scale), symptom severity (Young Mania Rating Scale (YMRS), Hamilton Rating Scale for Depression (HAM-D) (anxious depression), Montgomery-Åsberg Depression Rating Scale (MADRS) (melancholic depression)) and irritability (item 5 of the YMRS). FINDINGS Interestingly, irritability correlated with mania (r=0.734, p<0.001 (YMRS)) and depressive symptom scores (r=0.369, p<0.001 (MADRS); r=0.477, p<0.001 (HAM-D)), which in turn correlated with suicide ideation scores (r=0.364, p<0.01 (MADRS); r=0.275, p=0.017 (HAM-D)). However, despite this indirect association, there was no direct correlation between irritability and suicide ideation (r=0.050, p>0.05). CONCLUSIONS The nature of the relationship between irritability and suicidal ideation is determined by the emotional context within which irritability operates. CLINICAL IMPLICATIONS Findings suggest that rather than examining irritability alone, consideration of the subtype of depression, especially that of anxious depression, should be paramount in assessing suicide risk.
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Affiliation(s)
- Gin Malhi
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Erica Bell
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Pritha Das
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Tim Outhred
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
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