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Arnone D, Karmegam SR, Östlundh L, Alkhyeli F, Alhammadi L, Alhammadi S, Alkhoori A, Selvaraj S. Risk of suicidal behavior in patients with major depression and bipolar disorder - A systematic review and meta-analysis of registry-based studies. Neurosci Biobehav Rev 2024; 159:105594. [PMID: 38368970 DOI: 10.1016/j.neubiorev.2024.105594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/29/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024]
Abstract
Suicide is a health priority and one of the most common causes of death in mood disorders. One of the limitations of this type of research is that studies often establish rates of suicide behaviors in mood disorders by using diverse comparison groups or simply monitoring cohort of patients over a time period. In this registry-based systematic review, national registers were identified through searches in six academic databases, and information about the occurrence of suicide behaviors in mood disorders was systematically extracted. Odds ratios were subsequently calculated comparing rates of death by suicide in mood disorders in comparison with age and period matched rates of death by suicide in the general population obtained from country-wide national registers. The aim was to provide the most recent summary of epidemiological and clinical factors associated to suicide in mood disorders whilst calculating the likelihood of death by suicide in mood disorders in comparison with non-affected individuals according to national databases. The study follows the Preferred Reporting Guidelines for Systematic Reviews and Meta-analyses and was prespecify registered on Prospero (CRD42020186857). Results suggest that patients with mood disorders are at substantially increased risk of attempting and dying by suicide. Several epidemiological, clinical and social factors are reported to be associated with clinical populations at risk of suicide. Meta-analyses of completed deaths by suicide suggest that the likelihood for dying by suicide in mood disorders is 8.62 times higher in major depression and 8.66 times higher in bipolar disorder with higher number of untoward events in women compared to men in both conditions. The likelihood of dying by suicide in major depressive disorders is higher in the first year following discharge. Clinical guidelines might consider longer periods of monitoring following discharge from hospital. Overall, due to the higher risk of suicide in mood disorders, efforts should be made to increase detection and prevention whilst focusing on reducing risk in the most severe forms of illness with appropriate treatment to promote response and remission at the earliest convenience.
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Affiliation(s)
- Danilo Arnone
- Centre for Affective Disorders, Psychological Medicine, King's College London, London, United Kingdom; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Sendhil Raj Karmegam
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | | | - Fatima Alkhyeli
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Lamia Alhammadi
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shama Alhammadi
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amal Alkhoori
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sudhakar Selvaraj
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Intra-Cellular Therapies, Inc, USA
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Hu FH, Jia YJ, Zhao DY, Fu XL, Zhang WQ, Tang W, Hu SQ, Wu H, Ge MW, Du W, Shen WQ, Chen HL. Gender differences in suicide among patients with bipolar disorder: A systematic review and meta-analysis. J Affect Disord 2023; 339:601-614. [PMID: 37467799 DOI: 10.1016/j.jad.2023.07.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To examine gender differences in suicidal ideation, suicide attempts, and suicide deaths in patients with bipolar disorder. METHODS PubMed, Web of Science, and Embase were systematic searched from inception to March 7, 2023. Two reviewers extract data independently. Demographic data, the number of males and females with bipolar disorder, and the number of individuals with suicidal ideation, suicide attempts, and suicide deaths among participants were extracted. RESULTS The pooled prevalence of suicidal ideation in males and females was 48.0 % and 44.0 %, respectively, and the overall male-to-female ratios present a statistically insignificant result (OR = 0.95, 95%CI = 0.75-1.21) among patients with bipolar disorder. The pooled prevalence of suicide attempts in males and females was 6.7 % and 9.3 %, respectively, and there was a statistically significant lower prevalence among male patients with bipolar disorder (OR = 0.71, 95%CI = 0.67-0.75). However, the pooled prevalence of suicide deaths in males and females was 0.7 % and 0.3 % respectively, and there was a statistically significant higher prevalence among male patients with bipolar disorder (OR = 1.86, 95%CI = 1.63-2.13). LIMITATIONS The included studies were from mainly middle- and high-income countries and used inconsistent measurement tools. Thus, there is a potential for bias in our results. CONCLUSIONS Among patients with bipolar disorder, females were found to have a higher prevalence of suicide attempts, while males have a higher prevalence of suicide deaths. However, there is no significant gender difference in suicidal ideation. Efforts to optimize recognition, treatment, and administration in males and females may reduce gender differences.
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Affiliation(s)
- Fei-Hong Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Yi-Jie Jia
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Dan-Yan Zhao
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Xue-Lei Fu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wan-Qing Zhang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wen Tang
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Shi-Qi Hu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Hua Wu
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Meng-Wei Ge
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wei Du
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Wang-Qin Shen
- Medical School of Nantong University, Nantong, Jiangsu, PR China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, Jiangsu, PR China.
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Esposito CM, Barkin JL, Ceresa A, Nosari G, Di Paolo M, Legnani F, Cirella L, Surace T, Tagliabue I, Capuzzi E, Caldiroli A, Dakanalis A, Politi P, Clerici M, Buoli M. Are There Any Differences in Clinical and Biochemical Variables between Bipolar Patients with or without Lifetime Psychotic Symptoms? J Clin Med 2023; 12:5902. [PMID: 37762843 PMCID: PMC10531939 DOI: 10.3390/jcm12185902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Psychotic symptoms occur in more than half of patients affected by Bipolar Disorder (BD) and are associated with an unfavorable course of the disorder. The objective of this study is to identify the differences in the clinical and biochemical parameters between bipolar patients with or without psychotic symptoms. METHODS A total of 665 inpatients were recruited. Demographic, clinical, and biochemical data related to the first day of hospitalization were obtained via a screening of the clinical charts and intranet hospital applications. The two groups identified via the lifetime presence of psychotic symptoms were compared using t tests for quantitative variables and χ2 tests for qualitative ones; binary logistic regression models were subsequently performed. RESULTS Patients with psychotic BD (compared to non-psychotic ones) showed a longer duration of hospitalization (p < 0.001), higher Young Mania Rating Scale scores (p < 0.001), lower Global Assessment of Functioning scores (p = 0.002), a less frequent history of lifetime suicide attempts (p = 0.019), less achievement of remission during the current hospitalization (p = 0.028), and a higher Neutrophile to Lymphocyte Ratio (NLR) (p = 0.006), but lower total cholesterol (p = 0.018) and triglycerides (p = 0.013). CONCLUSIONS Patients with psychotic BD have a different clinical and biochemical profile compared to their counterparts, characterized by more clinical severity, fewer metabolic alterations, and a higher grade of inflammation. Further multi-center studies have to confirm the results of this present study.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Jennifer L. Barkin
- Department of Community Medicine, School of Medicine, Mercer University, Macon, GA 31207, USA;
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Guido Nosari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Martina Di Paolo
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Francesca Legnani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
| | - Luisa Cirella
- Healthcare Professionals Department, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Teresa Surace
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Ilaria Tagliabue
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Monza, Italy;
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, 20900 Monza, Italy; (T.S.); (I.T.); (E.C.); (A.C.); (M.C.)
- Department of Medicine and Surgery, University of Milano Bicocca, 20126 Monza, Italy;
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (A.C.); (G.N.); (M.D.P.); (F.L.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Smedler E, Sparding T, Jonsson L, Hörbeck E, Landén M. Association of premorbid intelligence with level of functioning and illness severity in bipolar disorder. J Affect Disord 2023; 324:449-454. [PMID: 36608850 DOI: 10.1016/j.jad.2022.12.113] [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: 03/21/2022] [Revised: 12/04/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bipolar disorder is a severe psychiatric syndrome defined by periodic mood shifts. Patients with bipolar disorder show cognitive impairments relative to healthy controls. The risk of developing schizophrenia, and partially also bipolar disorder, has previously been shown to increase with lower premorbid intelligence. It is not known if premorbid intelligence is associated with level of functioning and illness severity of people having developed bipolar disorder. METHODS We used multiple linear and ordinal regression to analyze how premorbid intelligence, as measured at conscription, associate with functional outcome and illness severity in Swedish male bipolar disorder patients (n = 788). RESULTS We found that lower premorbid intelligence is associated with lower percentage of time in work, after adjusting for age and bipolar subtype, and correcting for multiple comparisons. We also found a strong negative association with the total number of inpatient episodes and psychiatric comorbidity, but not with interepisodic remission, treatment with psychotherapy or lithium or the presence of any complicating socioeconomical factors. Adjusting for confounding genetic factors using polygenic risk scores for bipolar disorder and schizophrenia had no effect on the associations. LIMITATIONS This study lacks females and controls and may thus have lower generalizability. CONCLUSION In conclusion, premorbid intelligence is associated with both level of functioning and illness severity as well as comorbidity in bipolar disorder patients. Further research is needed to develop targeted interventions for this subgroup of bipolar disorder patients.
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Affiliation(s)
- Erik Smedler
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Timea Sparding
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Lina Jonsson
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Elin Hörbeck
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Mikael Landén
- Department of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Kendler KS, Ohlsson H, Mościcki EK, Sundquist J, Edwards AC, Sundquist K. Genetic liability to suicide attempt, suicide death, and psychiatric and substance use disorders on the risk for suicide attempt and suicide death: a Swedish national study. Psychol Med 2023; 53:1639-1648. [PMID: 37010214 PMCID: PMC10916711 DOI: 10.1017/s0033291721003354] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND How does genetic liability to suicide attempt (SA), suicide death (SD), major depression (MD), bipolar disorder (BD), schizophrenia (SZ), alcohol use disorder (AUD), and drug use disorder (DUD) impact on risk for SA and SD? METHODS In the Swedish general population born 1932-1995 and followed through 2017 (n = 7 661 519), we calculate family genetic risk scores (FGRS) for SA, SD, MD, BD, SZ, AUD, and DUD. Registration for SA and SD was assessed from Swedish national registers. RESULTS In univariate and multivariate models predicting SA, FGRS were highest for SA, AUD, DUD, and MD. In univariate models predicting SD, the strongest FGRS were AUD, DUD, SA, and SD. In multivariate models, the FGRS for SA and AUD were higher in predicting SA while the FGRS for SD, BD, and SZ were higher in predicting SD. Higher FGRS for all disorders significantly predicted both younger age at first SA and frequency of attempts. For SD, higher FGRS for MD, AUD, and SD predicted later age at SD. Mediation of FGRS effects on SA and SD was more pronounced for SD than SA, strongest for AUD, DUD, and SZ FGRS and weakest for MD. CONCLUSIONS FGRS for both SA and SD and for our five psychiatric disorders impact on risk for SA and SD in a complex manner. While some of the impact of genetic risk factors for psychiatric disorders on risk for SA and SD is mediated through developing the disorders, these risks also predispose directly to suicidal behaviors.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alexis C. Edwards
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
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Sher L. Testosterone and Suicidal Behavior in Bipolar Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2502. [PMID: 36767867 PMCID: PMC9915214 DOI: 10.3390/ijerph20032502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
Bipolar disorder is associated with suicidal behavior. The risk of suicide for individuals with bipolar disorder is up to 20-30 times larger than that of the general population. Considerable evidence suggests that testosterone may play a role in the pathophysiology of suicidal behavior in both men and women with bipolar disorder and other psychiatric conditions. Testosterone has complex effects on psychological traits. It affects mood and behavior, including interactions with other people. Testosterone regulates pro-active and re-active aspects of aggression. Probably, both high and low levels of testosterone may contribute to the neurobiology of suicide in various patient populations. The effects of endogenous and exogenous testosterone on suicidality in patients with bipolar disorder need further investigation. The aim of this commentary article is to provide a commentary on the author's work on the topic, summarize the literature on testosterone, bipolar disorder, and suicide, and encourage future research on this poorly studied topic.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY 10468, USA; ; Tel.: +1-718-584-9000
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
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Pålsson E, Melchior L, Lindwall Sundel K, Karanti A, Joas E, Nordenskjöld A, Agestam M, Runeson B, Landén M. Cohort profile: the Swedish National Quality Register for bipolar disorder(BipoläR). BMJ Open 2022; 12:e064385. [PMID: 36600380 PMCID: PMC9743376 DOI: 10.1136/bmjopen-2022-064385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The Swedish National Quality Register for bipolar affective disorder, BipoläR, was established in 2004 to provide nationwide indicators for quality assessment and development in the clinical care of individuals with bipolar spectrum disorder. An ancillary aim was to provide data for bipolar disorder research. PARTICIPANTS Inclusion criteria for registration in BipoläR is a diagnosis of bipolar spectrum disorder (ICD codes: F25.0, F30.1-F30.2, F30.8-F31.9, F34.0) and treatment at an outpatient clinic in Sweden. BipoläR collects data from baseline and annual follow-up visits throughout Sweden. Data is collected using questionnaires administered by healthcare staff. The questions cover sociodemographic, diagnostic, treatment, outcomes and patient reported outcome variables. The register currently includes 39 583 individual patients with a total of 75 423 baseline and follow-up records. FINDINGS TO DATE Data from BipoläR has been used in several peer-reviewed publications. Studies have provided knowledge on effectiveness, side effects and use of pharmacological and psychological treatment in bipolar disorder. In addition, findings on the diagnosis of bipolar disorder, risk factors for attempted and completed suicide and health economics have been reported. The Swedish Bipolar Collection project has contributed to a large number of published studies and provides important information on the genetic architecture of bipolar disorder, the impact of genetic variation on disease characteristics and treatment outcome. FUTURE PLANS Data collection is ongoing with no fixed end date. Currently, approximately 5000 new registrations are added each year. Cohort data are available via a formalised request procedure from Centre of Registers Västra Götaland (e-mail: registercentrum@vgregion.se). Data requests for research purposes require an entity responsible for the research and an ethical approval.
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Affiliation(s)
- Erik Pålsson
- Psychiatry and Neurochemistry, University of Gothenburg, Goteborg, Sweden
| | - Lydia Melchior
- Bipolarmottagning, Sahlgrenska University Hospital, Goteborg, Sweden
| | | | - Alina Karanti
- Psychiatry and Neurochemistry, University of Gothenburg, Goteborg, Sweden
| | - Erik Joas
- Psychiatry and Neurochemistry, University of Gothenburg, Goteborg, Sweden
| | - Axel Nordenskjöld
- University Health Care Research Centre, Faculty of Medicine and Health, Orebro Universitet, Orebro, Sweden
| | | | - Bo Runeson
- Psychiatry, Karolinska Institute, Stockholm, Sweden
| | - Mikael Landén
- Psychiatry and Neurochemistry, University of Gothenburg, Goteborg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Goldstein TR, Merranko J, Hafeman D, Gill MK, Liao F, Sewall C, Hower H, Weinstock L, Yen S, Goldstein B, Keller M, Strober M, Ryan N, Birmaher B. A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder. Bipolar Disord 2022; 24:749-757. [PMID: 36002150 DOI: 10.1111/bdi.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder. METHODS Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC. RESULTS There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history. CONCLUSIONS This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Craig Sewall
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Martin Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Strober
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Yilmaz S, Huguet A, Kisely S, Rao S, Wang J, Baur K, Price M, O'Mahen H, Wright K. Do psychological interventions reduce symptoms of depression for patients with bipolar I or II disorder? A meta-analysis. J Affect Disord 2022; 301:193-204. [PMID: 35007645 DOI: 10.1016/j.jad.2021.12.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychological therapies may play an important role in the treatment of bipolar disorders. Several meta-analyses that examine the effectiveness of psychotherapies for patients with bipolar disorder include conclusions about the impact upon bipolar depression. However, these tend not to consider differences in depression outcome depending upon whether the therapy primarily targets acute depression, nor severity of baseline depression. This may affect the conclusions drawn about the effectiveness of these therapies for acute bipolar depression treatment. OBJECTIVES This meta-analysis explored the effectiveness of psychological therapies in reducing bipolar depression, in particular examining whether: (1) the effect of therapy is greater when baseline depressive symptoms are more severe, and (2) the effect of therapy is greater when the primary focus of the therapy is the treatment of acute bipolar depression? DATA SOURCES A systematic search was conducted using the following electronic databases; Cochrane Controlled Register of Trials (1996), MEDLINE (1966 onwards), EMBASE (1980 onwards), PsycINFO (1974 onwards), Scopus, Web of Science and Clinical Trials Registries (listed at:https://www.hhs.gov/ohrp/international/clinical-trial-registries/index.html). ELIGIBILITY CRITERIA Eligible studies were randomized controlled trials evaluating a psychological intervention for adults diagnosed with Bipolar I or II disorder. The comparators were usual care, wait-list, placebo, active treatment control. Post-treatment depression status was required to be measured continuously using a validated self- or observer- report measure, or categorically by a validated diagnostic instrument or clinical diagnosis by a suitably qualified person. DATA EXTRACTION AND SYNTHESIS Titles and abstracts were screened, followed by full texts. Two reviewers conducted each stage until agreement was reached, and both independently extracted study information. Means, standard deviations (SDs) and number of participants were retrieved from articles and used to perform a meta-analysis. The primary outcome was depressive symptom score. RESULTS The database search identified 6388 studies. After removing the duplicates, 3298 studies remained, of which, 28 studies were included in the qualitative review and 22 in the meta-analysis. Effect sizes range from -1.99 [-2.50, -1.49] to 0.89 [-0.12, 1.90]. There was low quality evidence of a significant effect on symptoms of depression for cognitive behavioral therapy and dialectical behavior therapy. Trials of psychoeducation, mindfulness-based therapy, family therapy and interpersonal and social rhythm therapy showed no evidence of any effect on depression. We found no significant relationship between baseline depression score and depression outcome post-treatment when we controlled for therapy type and comparator. The result also showed that the effect sizes for studies targeting acute depression to be tightly clustered around a small overall effect size. CONCLUSIONS Some psychological therapies may reduce acute bipolar depression although this conclusion should be viewed with caution given the low quality of evidence. More research using similar therapy types and comparators is needed to better understand the relationship between depression status at baseline and outcome.
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Affiliation(s)
- Sakir Yilmaz
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK.
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Canada; Departament de Psicologia, Universitat Rovira I Virgili, Spain; IWK Health Center, Canada
| | - Steve Kisely
- Department of Community Health and Epidemiology, Dalhousie University, Canada; University of Queensland, Psychiatry, Australia; Metro South Addiction and Mental Health Epidemiology Service, Australia
| | - Sanjay Rao
- Faculty of Medicine, Psychiatry, University of Ottawa, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Ottawa, School of Epidemiology, Public Health and Preventive Medicine, Canada
| | | | | | - Heather O'Mahen
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
| | - Kim Wright
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Perry road, Exeter EX4 4QG, UK
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10
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Proteins associated with future suicide attempts in bipolar disorder: A large-scale biomarker discovery study. Mol Psychiatry 2022; 27:3857-3863. [PMID: 35697758 PMCID: PMC9708594 DOI: 10.1038/s41380-022-01648-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 02/08/2023]
Abstract
Suicide is a major cause of death worldwide. Several biological systems have been implicated in suicidal behavior but studies of candidate biomarkers have failed to produce clinically relevant biomarkers for suicide prediction. The objective of the present study was to identify novel candidate biomarkers for suicidal behavior. We used a nested case-control study design where a large cohort of patients with bipolar disorder (N = 5 110) were followed up to 8 years after blood sampling. We included patients that attempted suicide during follow-up (N = 348) and matched bipolar disorder patients from the same cohort who did not attempt suicide during the study period (N = 348) and analyzed a total of 92 proteins with a neuro exploratory multiplex panel. Using a multivariate classification algorithm devised to minimize bias in variable selection, we identified a parsimonious set of proteins that best discriminated bipolar disorder patients with and without prospective suicide attempts. The algorithm selected 16 proteins for the minimal-optimal classification model, which outperformed 500 models with permuted outcome (p = 0.0004) but had low sensitivity (53%) and specificity (64%). The candidate proteins were then entered in separate logistic regression models to calculate protein-specific associations with prospective suicide attempts. In individual analyses, three of these proteins were significantly associated with prospective suicide attempt (SCGB1A1, ANXA10, and CETN2). Most of the candidate proteins are novel to suicide research.
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11
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Identification of molecular signatures and pathways common to blood cells and brain tissue based RNA-Seq datasets of bipolar disorder: Insights from comprehensive bioinformatics approach. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100881] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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12
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Buoli M, Cesana BM, Bolognesi S, Fagiolini A, Albert U, Di Salvo G, Maina G, de Bartolomeis A, Pompili M, Palumbo C, Bondi E, Steardo L, De Fazio P, Amore M, Altamura M, Bellomo A, Bertolino A, Di Nicola M, Di Sciascio G, Fiorillo A, Sacchetti E, Sani G, Siracusano A, Di Lorenzo G, Tortorella A, Altamura AC, Dell'Osso B. Factors associated with lifetime suicide attempts in bipolar disorder: results from an Italian nationwide study. Eur Arch Psychiatry Clin Neurosci 2022; 272:359-370. [PMID: 34652488 PMCID: PMC8938374 DOI: 10.1007/s00406-021-01343-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/04/2021] [Indexed: 12/19/2022]
Abstract
The purpose of the present study was to detect demographic and clinical factors associated with lifetime suicide attempts in Bipolar Disorder (BD). A total of 1673 bipolar patients from different psychiatric departments were compared according to the lifetime presence of suicide attempts on demographic/clinical variables. Owing to the large number of variables statistically related to the dependent variable (presence of suicide attempts) at the univariate analyses, preliminary multiple logistic regression analyses were realized. A final multivariable logistic regression was then performed, considering the presence of lifetime suicide attempts as the dependent variable and statistically significant demographic/clinical characteristics as independent variables. The final multivariable logistic regression analysis showed that an earlier age at first contact with psychiatric services (odds ratio [OR] = 0.97, p < 0.01), the presence of psychotic symptoms (OR = 1.56, p < 0.01) or hospitalizations (OR = 1.73, p < 0.01) in the last year, the attribution of symptoms to a psychiatric disorder (no versus yes: OR = 0.71, partly versus yes OR = 0.60, p < 0.01), and the administration of psychoeducation in the last year (OR = 1.49, p < 0.01) were all factors associated with lifetime suicide attempts in patients affected by BD. In addition, female patients resulted to have an increased association with life-long suicidal behavior compared to males (OR: 1.02, p < 0.01). Several clinical factors showed complex associations with lifetime suicide attempts in bipolar patients. These patients, therefore, require strict clinical monitoring for their predisposition to a less symptom stabilization. Future research will have to investigate the best management strategies to improve the prognosis of bipolar subjects presenting suicidal behavior.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | | | | | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, Department of Mental Health, UCO Clinica Psichiatrica, ASUGI-Azienda Sanitaria Universitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | | | - Giuseppe Maina
- San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Andrea de Bartolomeis
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sapienza University of Rome, Rome, Italy
| | - Claudia Palumbo
- Department of Psychiatry, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Emi Bondi
- Department of Psychiatry, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Steardo
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Mario Altamura
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Alessandro Bertolino
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Emilio Sacchetti
- Department of Mental Health and Addiction Services, ASST Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Psychiatry and Clinical Psychology, Policlinico Tor Vergata Foundation, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Psychiatry and Clinical Psychology, Policlinico Tor Vergata Foundation, Rome, Italy
| | | | - A Carlo Altamura
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bernardo Dell'Osso
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, via G.B.Grassi 74, 20157, Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- CRC "Aldo Ravelli" for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
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13
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Bauer M, Glenn T, Achtyes ED, Alda M, Agaoglu E, Altınbaş K, Andreassen OA, Angelopoulos E, Ardau R, Vares EA, Aydin M, Ayhan Y, Baethge C, Bauer R, Baune BT, Balaban C, Becerra-Palars C, Behere AP, Behere PB, Belete H, Belete T, Belizario GO, Bellivier F, Belmaker RH, Benedetti F, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Brady C, Cabrera J, Cappucciati M, Castro AMP, Chen WL, Cheung EYW, Chiesa S, Crowe M, Cuomo A, Dallaspezia S, Del Zompo M, Desai P, Dodd S, Donix M, Etain B, Fagiolini A, Fellendorf FT, Ferensztajn-Rochowiak E, Fiedorowicz JG, Fountoulakis KN, Frye MA, Geoffroy PA, Gonzalez-Pinto A, Gottlieb JF, Grof P, Haarman BCM, Harima H, Hasse-Sousa M, Henry C, Høffding L, Houenou J, Imbesi M, Isometsä ET, Ivkovic M, Janno S, Johnsen S, Kapczinski F, Karakatsoulis GN, Kardell M, Kessing LV, Kim SJ, König B, Kot TL, Koval M, Kunz M, Lafer B, Landén M, Larsen ER, Lenger M, Lewitzka U, Licht RW, Lopez-Jaramillo C, MacKenzie A, Madsen HØ, Madsen SAKA, Mahadevan J, Mahardika A, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Martiny K, Mashima Y, McLoughlin DM, Meesters Y, Melle I, Meza-Urzúa F, Ming MY, Monteith S, Moorthy M, Morken G, Mosca E, Mozzhegorov AA, Munoz R, Mythri SV, Nacef F, Nadella RK, Nakanotani T, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Ouali U, Pantovic-Stefanovic M, Pariwatcharakul P, Petite J, Pfennig A, Ruiz YP, Pilhatsch M, Pinna M, Pompili M, Porter R, Quiroz D, Rabelo-da-Ponte FD, Ramesar R, Rasgon N, Ratta-Apha W, Ratzenhofer M, Redahan M, Reddy MS, Reif A, Reininghaus EZ, Richards JG, Ritter P, Rybakowski JK, Sathyaputri L, Scippa ÂM, Simhandl C, Severus E, Smith D, Smith J, Stackhouse PW, Stein DJ, Stilwell K, Strejilevich S, Su KP, Subramaniam M, Sulaiman AH, Suominen K, Tanra AJ, Tatebayashi Y, Teh WL, Tondo L, Torrent C, Tuinstra D, Uchida T, Vaaler AE, Veeh J, Vieta E, Viswanath B, Yoldi-Negrete M, Yalcinkaya OK, Young AH, Zgueb Y, Whybrow PC. Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder. Int J Bipolar Disord 2021; 9:26. [PMID: 34467430 PMCID: PMC8408297 DOI: 10.1186/s40345-021-00231-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Eric D Achtyes
- Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Esen Agaoglu
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kürşat Altınbaş
- Department of Psychiatry, Selcuk University Faculty of Medicine, Mazhar Osman Mood Center, Konya, Turkey
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elias Angelopoulos
- Department of Psychiatry, National and Capodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Raffaella Ardau
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Edgar Arrua Vares
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Memduha Aydin
- Department of Psychiatry, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Yavuz Ayhan
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Munster, Germany.,Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ceylan Balaban
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Aniruddh P Behere
- Child and Adolescent Psychiatry, Helen DeVos Children's Hospital, Michigan State University-CHM, Grand Rapids, MI, USA
| | - Prakash B Behere
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed University), Wardha, India
| | - Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gabriel Okawa Belizario
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Frank Bellivier
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique-Hôpitaux de Paris, INSERM UMR-S1144, Université de Paris, FondaMental Foundation, Paris, France
| | - Robert H Belmaker
- Professor Emeritus of Psychiatry, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Francesco Benedetti
- University Vita-Salute San Raffaele, Milan, Italy.,Psychiatry and Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Berk
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Yuly Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Şule Bicakci
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey.,Department of Psychiatry, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Thomas D Bjella
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Conan Brady
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Jorge Cabrera
- Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile
| | | | - Angela Marianne Paredes Castro
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
| | - Wei-Ling Chen
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | | | - Silvia Chiesa
- Department of Mental Health and Substance Abuse, Piacenza, Italy
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Alessandro Cuomo
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Sara Dallaspezia
- Psychiatry and Clinical Psychobiology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Seetal Dodd
- Deakin University, IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Markus Donix
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bruno Etain
- Département de Psychiatrie et de Médecine Addictologique, Assistance Publique-Hôpitaux de Paris, INSERM UMR-S1144, Université de Paris, FondaMental Foundation, Paris, France
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Frederike T Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | | | - Jess G Fiedorowicz
- Department of Psychiatry, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kostas N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Pierre A Geoffroy
- Département de Psychiatrie et d'addictologie, AP-HP, Hopital Bichat-Claude Bernard, Paris, France.,GHU Paris-Psychiatry and Neurosciences, 75014, Paris, France.,Université de Paris, NeuroDiderot, Inserm, Paris, France
| | - Ana Gonzalez-Pinto
- BIOARABA, Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - John F Gottlieb
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa and the Department of Psychiatry, University of Toronto, Ottawa, Canada
| | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Mathias Hasse-Sousa
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Chantal Henry
- Department of Psychiatry, GHU Paris Psychiatrie & Neurosciences, 75014, Paris, France.,Université de Paris, 75006, Paris, France
| | - Lone Høffding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Josselin Houenou
- Université Paris Est Créteil, INSERM, IMRB, Translational Neuropsychiatry, Fondation FondaMental, 94010, Créteil, France.,Université Paris Saclay, CEA, Neurospin, 91191, Gif-sur-Yvette, France
| | | | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Maja Ivkovic
- University Clinical Center of Serbia, Clinic for Psychiatry, Belgrade, Serbia
| | - Sven Janno
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - Simon Johnsen
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark
| | - Flávio Kapczinski
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gregory N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Seong Jae Kim
- Department of Psychiatry, Cheongju Hospital, Cheongju, South Korea
| | - Barbara König
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - Timur L Kot
- Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia
| | - Michael Koval
- Department of Neuroscience, Michigan State University, East Lansing, MI, USA
| | - Mauricio Kunz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik R Larsen
- Mental Health Department Odense, University Clinic and Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark
| | - Melanie Lenger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rasmus W Licht
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carlos Lopez-Jaramillo
- Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alan MacKenzie
- Forensic Psychiatry, University of Glasgow, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | | | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Agustine Mahardika
- Department of Psychiatry, Faculty of Medicine, Mataram University, Mataram, Indonesia
| | - Mirko Manchia
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.,Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Klaus Martiny
- Copenhagen University Hospitals, Psychiatric Centre Copenhagen, Copenhagen, Denmark
| | - Yuki Mashima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Declan M McLoughlin
- Department of Psychiatry, Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - Ybe Meesters
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fátima Meza-Urzúa
- National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Mok Yee Ming
- Department of General Psychiatry, Mood Disorders Unit, Institute of Mental Health, Singapore City, Singapore
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Muthukumaran Moorthy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology-NTNU, Trondheim, Norway.,Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Enrica Mosca
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Fethi Nacef
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Ravi K Nadella
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Takako Nakanotani
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - René Ernst Nielsen
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Adel Omrani
- Tunisian Bipolar Forum, Érable Médical Cabinet 324, Lac 2, Tunis, Tunisia
| | - Yamima Osher
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uta Ouali
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | | | - Pornjira Pariwatcharakul
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Joanne Petite
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Elblandklinikum Radebeul, Radebeul, Germany
| | - Marco Pinna
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Danilo Quiroz
- Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile
| | | | - Raj Ramesar
- SA MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Michaela Ratzenhofer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Maria Redahan
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland
| | - M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Eva Z Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Jenny Gringer Richards
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Leela Sathyaputri
- Departments of Psychiatry, Epidemiology, and Internal Medicine, Iowa Neuroscience Institute, The University of Iowa, Iowa City, IA, USA
| | - Ângela M Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - Christian Simhandl
- Bipolar Zentrum Wiener Neustadt, Sigmund Freud Privat Universität, Vienna, Austria
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Daniel Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - José Smith
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | - Paul W Stackhouse
- Science Directorate/Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA
| | - Dan J Stein
- Department of Psychiatry, MRC Unit On Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Kellen Stilwell
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Sergio Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | - Kuan-Pin Su
- College of Medicine, China Medical University (CMU), Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirsi Suominen
- Department of Social Services and Health Care, Psychiatry, City of Helsinki, Helsinki, Finland
| | - Andi J Tanra
- Department of Psychiatry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Setagaya, Tokyo, Japan
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Leonardo Tondo
- McLean Hospital-Harvard Medical School, Boston, MA, USA.,Mood Disorder Lucio Bini Centers, Cagliari e Roma, Italy
| | - Carla Torrent
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Daniel Tuinstra
- Pine Rest Christian Mental Health Services, Grand Rapids, MI, USA
| | - Takahito Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Arne E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology-NTNU, Trondheim, Norway.,Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Maria Yoldi-Negrete
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñíz, Mexico City, Mexico
| | - Oguz Kaan Yalcinkaya
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Yosra Zgueb
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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14
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Richardson C, Robb KA, O'Connor RC. A systematic review of suicidal behaviour in men: A narrative synthesis of risk factors. Soc Sci Med 2021; 276:113831. [PMID: 33780831 DOI: 10.1016/j.socscimed.2021.113831] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/30/2020] [Accepted: 03/06/2021] [Indexed: 12/17/2022]
Abstract
RATIONALE Suicides by men outnumber those by women in every country of the world. To date, there has not been a comprehensive systematic review of risk factors for suicidal behaviour in men to better understand the excess deaths by suicide in men. OBJECTIVE The present systematic review seeks to determine the nature and extent of the risk factors to predict suicidal behaviour in men over time. METHODS A range of databases (CINAHL, PsycINFO, Web of Science Core Collection, Pubmed, Embase, and Psychology and Behavioural Sciences Collection) were searched from inception to January 2020 for eligible articles. The findings were collated through a narrative synthesis of the evidence. RESULTS An initial 601 studies were identified. Following the inclusion and exclusion criteria, there were 105 eligible studies (62 prospective and 43 retrospective) identified. Overall, the risk factors with the strongest evidence predicting suicidal behaviour in men were alcohol and/or drug use/dependence; being unmarried, single, divorced, or widowed; and having a diagnosis of depression. In the prospective studies, the most consistent evidence was for sociodemographic factors (19 risk factors), mental health/psychiatric illness (16 risk factors), physical health/illness (13 risk factors), and negative life events/trauma (11 risk factors). There were a small number of psychological factors (6 factors) and characteristics of suicidal behaviour (3 factors) identified. The findings from the retrospective studies provided further evidence for the risk factors identified in the prospective studies. CONCLUSIONS This systematic review has highlighted the wide range of risk factors for suicidal behaviour in men, in this review alone 68 different risk factors were identified. Many factors can interact and change in relevance throughout an individual's life. This review has identified extensive gaps in our knowledge as well as suggestions for future research.
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Affiliation(s)
- Cara Richardson
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
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15
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Neuroprogression as an Illness Trajectory in Bipolar Disorder: A Selective Review of the Current Literature. Brain Sci 2021; 11:brainsci11020276. [PMID: 33672401 PMCID: PMC7926350 DOI: 10.3390/brainsci11020276] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023] Open
Abstract
Bipolar disorder (BD) is a chronic and disabling psychiatric condition that is linked to significant disability and psychosocial impairment. Although current neuropsychological, molecular, and neuroimaging evidence support the existence of neuroprogression and its effects on the course and outcome of this condition, whether and to what extent neuroprogressive changes may impact the illness trajectory is still poorly understood. Thus, this selective review was aimed toward comprehensively and critically investigating the link between BD and neurodegeneration based on the currently available evidence. According to the most relevant findings of the present review, most of the existing neuropsychological, neuroimaging, and molecular evidence demonstrates the existence of neuroprogression, at least in a subgroup of BD patients. These studies mainly focused on the most relevant effects of neuroprogression on the course and outcome of BD. The main implications of this assumption are discussed in light of specific shortcomings/limitations, such as the inability to carry out a meta-analysis, the inclusion of studies with small sample sizes, retrospective study designs, and different longitudinal investigations at various time points.
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16
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Clinical and genetic differences between bipolar disorder type 1 and 2 in multiplex families. Transl Psychiatry 2021; 11:31. [PMID: 33431802 PMCID: PMC7801527 DOI: 10.1038/s41398-020-01146-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023] Open
Abstract
The two major subtypes of bipolar disorder (BD), BD-I and BD-II, are distinguished based on the presence of manic or hypomanic episodes. Historically, BD-II was perceived as a less severe form of BD-I. Recent research has challenged this concept of a severity continuum. Studies in large samples of unrelated patients have described clinical and genetic differences between the subtypes. Besides an increased schizophrenia polygenic risk load in BD-I, these studies also observed an increased depression risk load in BD-II patients. The present study assessed whether such clinical and genetic differences are also found in BD patients from multiplex families, which exhibit reduced genetic and environmental heterogeneity. Comparing 252 BD-I and 75 BD-II patients from the Andalusian Bipolar Family (ABiF) study, the clinical course, symptoms during depressive and manic episodes, and psychiatric comorbidities were analyzed. Furthermore, polygenic risk scores (PRS) for BD, schizophrenia, and depression were assessed. BD-I patients not only suffered from more severe symptoms during manic episodes but also more frequently showed incapacity during depressive episodes. A higher BD PRS was significantly associated with suicidal ideation. Moreover, BD-I cases exhibited lower depression PRS. In line with a severity continuum from BD-II to BD-I, our results link BD-I to a more pronounced clinical presentation in both mania and depression and indicate that the polygenic risk load of BD predisposes to more severe disorder characteristics. Nevertheless, our results suggest that the genetic risk burden for depression also shapes disorder presentation and increases the likelihood of BD-II subtype development.
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17
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Chakroun M, Zgueb Y, Khaled DB, Ouali U, Jomli R, Nacef F. [What are the characteristics of patients with bipolar disorder type I who attempt suicide?]. Pan Afr Med J 2020; 37:116. [PMID: 33425149 PMCID: PMC7755363 DOI: 10.11604/pamj.2020.37.116.24787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/29/2020] [Indexed: 11/11/2022] Open
Abstract
Suicide is a public health problem affecting majority of patients with psychiatric diseases, including bipolar disorder (BD). The purpose of this study was to estimate the prevalence of suicide attempts (SAs) and to identify different factors associated with it in a population of patients with bipolar disorder type I (BD I). We conducted a cross-sectional and descriptive study of 150 patients. We used a fact sheet, questionnaires assessing affective temperaments, alcohol addiction and drug addiction. A comparison between suicidal (23,3%, n = 35) and non-suicidal (76,7%, n = 115) subjects enabled the identification of the following risk factors for suicide: cannabis addiction, addiction to psychotropic drugs, advanced age, a family history of BD, depression, SA and suicide deaths, a personal somatic history, a personality disorder associated, in particular, with histrionic personality, depressive temperament, a first thymic depressive episode, recurrent thymic episodes and long-term disease progression. Two protective factors were also identified: valproic acid and a higher number of siblings. In a multivariate study risk factors included: age, a family history of BD, a family history of SA and cannabis addiction. Particular attention should be given to determinants associated with suicidal behavior in BD I patients in order to adopt effective preventive and therapeutic strategies.
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Affiliation(s)
- Mariem Chakroun
- Service de Psychiatrie «A», Hôpital Razi, la Manouba, Tunis, Tunisie
| | - Yosra Zgueb
- Service de Psychiatrie «A», Hôpital Razi, la Manouba, Tunis, Tunisie
| | - Donia Ben Khaled
- Service de Psychiatrie «A», Hôpital Razi, la Manouba, Tunis, Tunisie
| | - Uta Ouali
- Service de Psychiatrie «A», Hôpital Razi, la Manouba, Tunis, Tunisie
| | - Rabaa Jomli
- Service de Psychiatrie «A», Hôpital Razi, la Manouba, Tunis, Tunisie
| | - Fethi Nacef
- Service de Psychiatrie «A», Hôpital Razi, la Manouba, Tunis, Tunisie
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18
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Iliachenko EK, Ragazan DC, Eberhard J, Berge J. Suicide mortality after discharge from inpatient care for bipolar disorder: A 14-year Swedish national registry study. J Psychiatr Res 2020; 127:20-27. [PMID: 32450359 DOI: 10.1016/j.jpsychires.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21-0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48-1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41-3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.
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Affiliation(s)
- Elena K Iliachenko
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Dragos C Ragazan
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Jonas Eberhard
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden.
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19
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Biological Targets Underlying the Antisuicidal Effects of Lithium. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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20
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Karanti A, Kardell M, Joas E, Runeson B, Pålsson E, Landén M. Characteristics of bipolar I and II disorder: A study of 8766 individuals. Bipolar Disord 2020; 22:392-400. [PMID: 31724302 DOI: 10.1111/bdi.12867] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Large-scale studies on phenotypic differences between bipolar disorder type I (BDI) and type II (BDII) are scarce. METHODS Individuals with BDI (N = 4806) and BDII (N = 3960) were compared with respect to clinical features, illness course, comorbid conditions, suicidality, and socioeconomic factors using data from the Swedish national quality assurance register for bipolar disorders (BipoläR). RESULTS BDII had higher rate of depressive episodes and more frequent suicide attempts than BDI. Furthermore, the BDII group were younger at first sign of mental illness and showed higher prevalence of psychiatric comorbidity but were more likely to have completed higher education and to be self-sustaining than the BDI group. BDII more frequently received psychotherapy, antidepressants, and lamotrigine. BDI patients had higher rate of hospitalizations and elated episodes, higher BMI, and higher rate of endocrine, nutritional, and metabolic diseases. BDI were more likely to receive mood stabilizers, antipsychotic drugs, electroconvulsive therapy, and psychoeducation. CONCLUSIONS These results demonstrate clear differences between BDI and II and counter the notion that BDII is a milder form of BDI, but rather a more complex condition with regard to clinical course and comorbidity.
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Affiliation(s)
- Alina Karanti
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Joas
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bo Runeson
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Erik Pålsson
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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21
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Wagner-Skacel J, Bengesser S, Dalkner N, Mörkl S, Painold A, Hamm C, Pilz R, Rieger A, Kapfhammer HP, Hiebler-Ragger M, Jauk E, Butler MI, Reininghaus EZ. Personality Structure and Attachment in Bipolar Disorder. Front Psychiatry 2020; 11:410. [PMID: 32477186 PMCID: PMC7233168 DOI: 10.3389/fpsyt.2020.00410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden. METHODS Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load. RESULTS We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population. LIMITATIONS Our limitations are the small sample size of our group and the lack of a control group. CONCLUSION In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Department of Medical Psychology and Psychotherapy, MUG, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Michaela Hiebler-Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Gruener Kreis Society, Center for Integrative Addiction Research, Johnsdorf, Austria
| | - Emanuel Jauk
- Institute of Psychology, University of Graz, Graz, Austria
- Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Mary I. Butler
- Department for Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
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22
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Subramanian K, Menon V, Sarkar S, Chandrasekaran V, Selvakumar N. Study of Risk Factors Associated with Suicide Attempt in Patients with Bipolar Disorder Type I. J Neurosci Rural Pract 2020; 11:291-298. [PMID: 32367986 PMCID: PMC7195972 DOI: 10.1055/s-0040-1709347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background
Suicide is the leading contributor to mortality in bipolar disorder (BD). A history of suicidal attempt is a robust predictive marker for future suicide attempts. Personality profiles and coping strategies are the areas of contemporary research in bipolar suicides apart from clinical and demographic risk factors. However, similar research in developing countries is rarer.
Objectives
The present study aimed to identify the risk factors associated with suicidal attempts in BD type I (BD-I).
Materials and Methods
Patients with BD-I currently in clinical remission (
N
= 102) were recruited. Sociodemographic details and the clinical data were collected using a semistructured pro forma. The psychiatric diagnoses were confirmed using the Mini-International Neuropsychiatric Interview 5.0. The National Institute of Mental Health–Life Chart Methodology Clinician Retrospective Chart was used to chart the illness course. Presumptive Stressful Life Events Scale, Coping Strategies Inventory Short Form, Buss–Perry aggression questionnaire, Past Feelings and Acts of Violence, and Barratt Impulsivity scale were used to assess the patient’s stress scores, coping skills, aggression, violence, and impulsivity, respectively.
Statistical Analysis
Descriptive statistics were used for demographic details and characteristics of the illness course. Binary logistic regression analyses were performed to identify the predictors for lifetime suicide attempt in BD-I.
Results
A total of 102 patients (males = 49 and females = 53) with BD-I were included. Thirty-seven subjects (36.3%) had a history of suicide attempt. The illness course in suicide attempters more frequently had an index episode of depression, was encumbered with frequent mood episodes, especially in depression, and had a higher propensity for psychiatric comorbidities. On binary logistic regression analysis, the odds ratios (ORs) for predicting a suicide attempt were highest for positive family history of suicide (OR: 13.65, 95% confidence interval [CI]: 1.28–145.38,
p
= 0.030), followed by the presence of an index depressive episode (OR: 6.88, 95% CI: 1.70–27.91,
p
= 0.007), and lower scores on problem-focused disengagement (OR: 0.72, 95% CI: 0.56–0.92,
p
= 0.009).
Conclusion
BD-I patients with lifetime suicide attempt differ from non-attempters on various course-related and temperamental factors. However, an index episode depression, family history of suicide, and lower problem-focused engagement can predict lifetime suicide attempt in patients with BD-I.
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Affiliation(s)
- Karthick Subramanian
- Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed-to-be University), Puducherry, India
| | - Vikas Menon
- Department of Psychiatry, JIPMER, Puducherry, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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23
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Aytac HM, Oyaci Y, Yazar MS, Erol A, Pehlivan S. Association of MIF and MBL2 gene polymorphisms with attempted suicide in patients diagnosed with schizophrenia or bipolar disorder. J Clin Neurosci 2020; 78:264-268. [PMID: 32279906 DOI: 10.1016/j.jocn.2020.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
The aim of this study to investigate the genetic polymorphisms in macrophage inhibitory factor (MIF) and mannose-binding lectin 2 (MBL2) gene in schizophrenia (SCZ) or bipolar disorder (BD) patients with attempted suicide by comparing with a non-attempted SCZ or BD patients and healthy controls. A sample of 108 patients with SCZ, 100 patients with BD and 100 healthy volunteers were included in the study. SCID-I was used to confirm the diagnosis according to DSM-IV-TR criteria. The patients were evaluated by data forms that included sociodemographic, suicidal behavior and symptom severity information. PCR-RFLP was used to determine MIF and MBL2 gene polymorphisms from DNA material. Our results demonstrated that the distributions of MBL2 genotype (AA, AB, BB), combined genotype (AA, AB/BB) and the allele frequencies (A, B) of attempted suicide patients in SCZ were significantly different from the non-attempted SCZ patients. The distributions of the MBL2 genotype of attempted suicide patients in SCZ were significantly different from the control group. The distributions of MIF genotype (GG, GC, CC), combined genotype (GG, GC/CC) and the allele frequencies (G, C) of attempted suicide patients in BD were significantly different from the non-attempted BD patients or control group. In summary MBL2 gene polymorphism may be associated with attempted suicide in SCZ and MIF gene polymorphism might be associated with attempted suicide in BD. However, further studies with other gene variants in different ethnic populations are needed to address the exact role of these polymorphisms in SCZ or BD.
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Affiliation(s)
| | - Yasemin Oyaci
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
| | - Menekse Sila Yazar
- Department of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey.
| | - Ayse Erol
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
| | - Sacide Pehlivan
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University, Turkey.
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Lewis KJS, Richards A, Karlsson R, Leonenko G, Jones SE, Jones HJ, Gordon-Smith K, Forty L, Escott-Price V, Owen MJ, Weedon MN, Jones L, Craddock N, Jones I, Landén M, O’Donovan MC, Di Florio A. Comparison of Genetic Liability for Sleep Traits Among Individuals With Bipolar Disorder I or II and Control Participants. JAMA Psychiatry 2020; 77:303-310. [PMID: 31751445 PMCID: PMC6902167 DOI: 10.1001/jamapsychiatry.2019.4079] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Insomnia, hypersomnia, and an evening chronotype are common in individuals with bipolar disorder (BD), but whether this reflects shared genetic liability is unclear. Stratifying by BD subtypes could elucidate this association and inform sleep and BD research. OBJECTIVE To assess whether polygenic risk scores (PRSs) for sleep traits are associated with BD subtypes I and II. DESIGN, SETTING, AND PARTICIPANTS This case-control study was conducted in the United Kingdom and Sweden with participants with BD and control participants. Multinomial regression was used to assess whether PRSs for insomnia, daytime sleepiness, sleep duration, and chronotype are associated with BD subtypes compared with control participants. Affected individuals were recruited from the Bipolar Disorder Research Network. Control participants were recruited from the 1958 British Birth Cohort and the UK Blood Service. Analyses were repeated in an independent Swedish sample from August 2018 to July 2019. All participants were of European ancestry. EXPOSURES Standardized PRSs derived using alleles from genome-wide association studies of insomnia, sleep duration, daytime sleepiness, and chronotype. These were adjusted for the first 10 population principal components, genotyping platforms, and sex. MAIN OUTCOMES AND MEASURES Association of PRSs with BD subtypes, determined by semistructured psychiatric interview and case notes. RESULTS The main analysis included 4672 participants with BD (3132 female participants [67.0%]; 3404 with BD-I [72.9%]) and 5714 control participants (2812 female participants [49.2%]). Insomnia PRS was associated with increased risk of BD-II (relative risk [RR], 1.14 [95% CI, 1.07-1.21]; P = 8.26 × 10-5) but not BD-I (RR, 0.98 [95% CI, 0.94-1.03]; P = .409) relative to control participants. Sleep-duration PRS was associated with BD-I (RR, 1.10 [95% CI, 1.06-1.15]; P = 1.13 × 10-5) but not BD-II (RR, 0.99 [95% CI, 0.93-1.06]; P = .818). Associations between (1) insomnia PRS and BD-II and (2) sleep-duration PRS and BD-I were replicated in the Swedish sample of 4366 individuals with BD (2697 female participants [61.8%]; 2627 with BD-I [60.2%]) and 6091 control participants (3767 female participants [61.8%]). Chronotype and daytime-sleepiness PRS were not associated with BD subtypes. CONCLUSIONS AND RELEVANCE Per this analysis, BD subtypes differ in genetic liability to insomnia and hypersomnia, providing further evidence that the distinction between BD-I and BD-II has genetic validity. This distinction will be crucial in selecting participants for future research on the role of sleep disturbance in BD.
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Affiliation(s)
- Katie J. S. Lewis
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Richards
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Robert Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ganna Leonenko
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Samuel E. Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Hannah J. Jones
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom,National Institute of Health Research Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom
| | - Katherine Gordon-Smith
- Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom
| | - Liz Forty
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Valentina Escott-Price
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Michael J. Owen
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Michael N. Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, United Kingdom
| | - Lisa Jones
- Department of Psychological Medicine, University of Worcester, Worcester, United Kingdom
| | - Nick Craddock
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Ian Jones
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Institute of Neuroscience and Physiology, Sahlgenska Academy at the Gothenburg University, Gothenburg, Sweden
| | - Michael C. O’Donovan
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
| | - Arianna Di Florio
- Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom,National Centre for Mental Health, Cardiff University, Cardiff, United Kingdom
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Kim JS, Kang ES, Bahk YC, Jang S, Hong KS, Baek JH. Exploratory Analysis of Behavioral Impulsivity, Pro-inflammatory Cytokines, and Resting-State Frontal EEG Activity Associated With Non-suicidal Self-Injury in Patients With Mood Disorder. Front Psychiatry 2020; 11:124. [PMID: 32174860 PMCID: PMC7057238 DOI: 10.3389/fpsyt.2020.00124] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/12/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction: Non-suicidal self-injury (NSSI) is a rapidly increasing mental health problem that requires more clinical attention. In this study, we aimed to explore the biobehavioral markers of NSSI in participants with mood disorders. Methods: A total of 45 participants with mood disorders (bipolar I, II, and major depressive disorder) were included in the study. Behavioral impulsivity was measured using the immediate memory task (IMT)/delayed memory task (DMT) and the go-no-go (GNG) tests. Plasma levels of tumor necrosis factor-α (TNF-α), interleukin 1 beta (IL-1 β), and interleukin 6 (IL-6) and resting-state quantitative electroencephalography (qEEG) were measured. Results: The NSSI group had shorter GNG reaction time (GNG-RT) and higher TNF-α levels compared to the non-NSSI group. TNF-α was positively correlated with frontal theta power. In addition, GNG-RT showed a significant positive association with frontal alpha activity. Conclusion: NSSI in mood disorders was associated with increased behavioral impulsivity and greater inflammation. Increased pro-inflammatory cytokines were associated with frontal theta power. Increased inflammation might change major neurotransmitter metabolism, which eventually affects frontal function and decreases response inhibition. Further studies to explore their causal relationship are warranted.
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Affiliation(s)
- Ji Sun Kim
- Department of Psychiatry, Sooncheonhyang University Cheonan Hospital, Cheonan, South Korea
| | - Eun-Sook Kang
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Chun Bahk
- Samsung Biomedical Research Institute, Seoul, South Korea
| | - Sunglee Jang
- Samsung Biomedical Research Institute, Seoul, South Korea
| | - Kyung Sue Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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26
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Rosso G, Albert U, Bramante S, Aragno E, Quarato F, Di Salvo G, Maina G. Correlates of violent suicide attempts in patients with bipolar disorder. Compr Psychiatry 2020; 96:152136. [PMID: 31734642 DOI: 10.1016/j.comppsych.2019.152136] [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: 06/07/2019] [Revised: 08/14/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Suicide is one of the leading causes of death in bipolar disorder (BD); violent suicide attempts are associated with the highest level of lethality. We aimed to evaluate factors related to the risk of violent suicide in a large naturalistic sample of patients with BD; in addition, we analyzed the rates of lifetime suicide attempts and the variables associated with suicidal behavior. METHODS We recruited 847 patients with BD. Patients were grouped according to whether they had a lifetime history of suicide attempts and, among suicide attempters, subjects who had used a violent suicide method were compared with those who had attempted suicide with a nonviolent method. Comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. Logistic regression (LogReg) was used to identify explanatory variables associated with violent suicide attempts (dependent variable). RESULTS Two hundred and two patients (24%) had a lifetime history of suicide attempts. Subjects with at least one lifetime suicide attempt showed longer duration of illness (22.4±14.1 years vs 19.9±14.2 years: p 0.028), more lifetime hypomanic episodes (3.3±4.3 vs 2.3±3.1: p0.001), more lifetime depressive episodes (6.0±4.4 vs 4.7±4.1: p<0.001), higher rates of lifetime psychiatric comorbidities (50.0% vs 41.3%: p 0.029), higher rates of lifetime medical comorbidities (58.0% vs 48.9%: p 0.028) and higher rates of reduced HDL cholesterol (46.2% vs 36.7%: p 0.030). Among suicide attempters, fifty-two patients (30.6%) attempted suicide with a violent method. We found more men in the group of violent suicide attempters than in the group of nonviolent suicide attempters (65% vs 28%; p: <0.001). Moreover subjects with previous violent attempts showed higher mean values of weight (80.5±18.3 vs 69.4±14.7: p<0.001), body mass index (27.8±5.6 vs 25.2±4.7: p<0.003) and waist circumference (98.7±18.5 vs 92.4±14.3: p 0.032). The LogReg analysis confirmed the association of violent attempts with male gender (p: <0.001; Phi: 0.35) and higher waist circumference (p: <0.001; Cohen's d: 0.39). LIMITATIONS In our research we analyzed lifetime suicide attempts, but the sample does not include completed suicides, meaning that we are unable to test whether the results are generalizable to suicide deaths. Moreover, some relevant variables, such as medical comorbidities/metabolic parameters at the time of suicide attempts and previous medication, were not collected. Another limitation concerns the heterogeneity of recruited patients in terms of clinical characteristics (e.g.: medical conditions, drug treatments), with potential confounding factors. CONCLUSIONS The present study confirms the association between male gender and violent suicide and suggests a correlation between obesity and the use of violent suicide methods. The relationship between obesity and suicidal behaviour is worthy of interest and deserves to be explored by further studies.
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Affiliation(s)
- Gianluca Rosso
- Psychiatric Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, Psychiatric Section, University of Trieste, Via Guglielmo de Pastrovic 4, 34128, Trieste, Italy
| | - Stefano Bramante
- Psychiatric Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neurosciences "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Elena Aragno
- Psychiatric Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neurosciences "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Federica Quarato
- Psychiatric Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neurosciences "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Gabriele Di Salvo
- Psychiatric Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neurosciences "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Giuseppe Maina
- Psychiatric Unit, San Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano, Turin, Italy; Department of Neurosciences "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Turin, Italy.
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27
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Smedler E, Bergen SE, Song J, Landén M. Genes, biomarkers, and clinical features associated with the course of bipolar disorder. Eur Neuropsychopharmacol 2019; 29:1152-1160. [PMID: 31378653 DOI: 10.1016/j.euroneuro.2019.07.132] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/05/2019] [Accepted: 07/15/2019] [Indexed: 01/21/2023]
Abstract
There is considerable variability in the severity of bipolar disorder, e.g., in terms of the frequency of inpatient episodes. The long-term progression also differs, where some patients are sensitised with progressively shorter healthy intervals. Little is known about the proportion of patients being sensitised, their clinical characteristics, and biological underpinnings. We analysed long-term progression of bipolar disorder in relation to clinical characteristics (N = 3074), serum biomarkers (N = 745), and genetic variants (N = 1401) in a cohort of Swedish bipolar disorder patients. We took advantage of the National Patient Register, providing reliable data on 35,973 psychiatric inpatient care episodes in Sweden since 1973. First, one third of the cohort cluster together with a maximum of one inpatient episode per year, while the remaining two thirds had >1 episode per year. These groups did not differ with respect to clinical features or biomarkers. Second, among patients with at least five inpatient episodes (defined as severely ill), we find one group with progressively shorter cycle-lengths (one fifth of the total cohort, N = 550). Compared with those with a stable or recuperant trajectory, these patients featured lower functioning, more antidepressant treatment, as well as reduced levels of inflammatory markers in serum. Third, sensitisation was associated with a common genetic variant near the calcium channel gene CACNA2D3 at genome-wide significance. These results suggest the potential for translational research aimed at preventive actions.
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Affiliation(s)
- Erik Smedler
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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28
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Dome P, Rihmer Z, Gonda X. Suicide Risk in Bipolar Disorder: A Brief Review. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E403. [PMID: 31344941 PMCID: PMC6723289 DOI: 10.3390/medicina55080403] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022]
Abstract
Bipolar disorders (BDs) are prevalent mental health illnesses that affect about 1-5% of the total population, have a chronic course and are associated with a markedly elevated premature mortality. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, the rate of suicide among BD patients is approximately 10-30 times higher than the corresponding rate in the general population. Extant research found that up to 20% of (mostly untreated) BD subjects end their life by suicide, and 20-60% of them attempt suicide at least one in their lifetime. In our paper we briefly recapitulate the current knowledge on the epidemiological aspects of suicide in BD as well as factors associated with suicidal risk in BD. Furthermore, we also discuss concisely the possible means of suicide prevention in BD.
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Affiliation(s)
- Peter Dome
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary.
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary.
| | - Zoltan Rihmer
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, 1125 Budapest, Hungary
- National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, 1135 Budapest, Hungary
- MTA-SE Neuropsychopharmacology, Neurochemistry Research Group, Hungarian Academy of Sciences, 1089 Budapest, Hungary
- NAP-2-SE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, 1089 Budapest, Hungary
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29
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Nascimento C, Nunes VP, Diehl Rodriguez R, Takada L, Suemoto CK, Grinberg LT, Nitrini R, Lafer B. A review on shared clinical and molecular mechanisms between bipolar disorder and frontotemporal dementia. Prog Neuropsychopharmacol Biol Psychiatry 2019; 93:269-283. [PMID: 31014945 PMCID: PMC6994228 DOI: 10.1016/j.pnpbp.2019.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022]
Abstract
Mental disorders are highly prevalent and important causes of medical burden worldwide. Co-occurrence of neurological and psychiatric symptoms are observed among mental disorders, representing a challenge for their differential diagnosis. Psychiatrists and neurologists have faced challenges in diagnosing old adults presenting behavioral changes. This is the case for early frontotemporal dementia (FTD) and bipolar disorder. In its initial stages, FTD is characterized by behavioral or language disturbances in the absence of cognitive symptoms. Consequently, patients with the behavioral subtype of FTD (bv-FTD) can be initially misdiagnosed as having a psychiatric disorder, typically major depression disorder (MDD) or bipolar disorder (BD). Bipolar disorder is associated with a higher risk of dementia in older adults and with cognitive impairment, with a subset of patients presents a neuroprogressive pattern during the disease course. No mendelian mutations were identified in BD, whereas three major genetic causes of FTD have been identified. Clinical similarities between BD and bv-FTD raise the question whether common molecular pathways might explain shared clinical symptoms. Here, we reviewed existing data on clinical and molecular similarities between BD and FTD to propose biological pathways that can be further investigated as common or specific markers of BD and FTD.
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Affiliation(s)
- Camila Nascimento
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Villela Paula Nunes
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Roberta Diehl Rodriguez
- Behavioral and Cognitive Neurology Unit, Department of Neurology and LIM 22, University of São Paulo, São Paulo 05403-900, Brazil
| | - Leonel Takada
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo, São Paulo 05403-900, Brazil
| | - Cláudia Kimie Suemoto
- Division of Geriatrics, LIM-22, University of São Paulo Medical School, São Paulo 01246-90, Brazil
| | - Lea Tenenholz Grinberg
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo 01246-90, Brazil; Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143-120, USA.
| | - Ricardo Nitrini
- Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo, São Paulo 05403-900, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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30
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Bauer M, Glenn T, Alda M, Andreassen OA, Angelopoulos E, Ardau R, Ayhan Y, Baethge C, Bauer R, Baune BT, Becerra-Palars C, Bellivier F, Belmaker RH, Berk M, Bersudsky Y, Bicakci Ş, Birabwa-Oketcho H, Bjella TD, Cabrera J, Wo Cheung EY, Del Zompo M, Dodd S, Donix M, Etain B, Fagiolini A, Fountoulakis KN, Frye MA, Gonzalez-Pinto A, Gottlieb JF, Grof P, Harima H, Henry C, Isometsä ET, Janno S, Kapczinski F, Kardell M, Khaldi S, Kliwicki S, König B, Kot TL, Krogh R, Kunz M, Lafer B, Landén M, Larsen ER, Lewitzka U, Licht RW, Lopez-Jaramillo C, MacQueen G, Manchia M, Marsh W, Martinez-Cengotitabengoa M, Melle I, Meza-Urzúa F, Ming MY, Monteith S, Morken G, Mosca E, Mozzhegorov AA, Munoz R, Mythri SV, Nacef F, Nadella RK, Nery FG, Nielsen RE, O'Donovan C, Omrani A, Osher Y, Sørensen HØ, Ouali U, Ruiz YP, Pilhatsch M, Pinna M, da Ponte FDR, Quiroz D, Ramesar R, Rasgon N, Reddy MS, Reif A, Ritter P, Rybakowski JK, Sagduyu K, Raghuraman BS, Scippa ÂM, Severus E, Simhandl C, Stackhouse PW, Stein DJ, Strejilevich S, Subramaniam M, Sulaiman AH, Suominen K, Tagata H, Tatebayashi Y, Tondo L, Torrent C, Vaaler AE, Vares E, Veeh J, Vieta E, Viswanath B, Yoldi-Negrete M, Zetin M, Zgueb Y, Whybrow PC. Association between solar insolation and a history of suicide attempts in bipolar I disorder. J Psychiatr Res 2019; 113:1-9. [PMID: 30878786 DOI: 10.1016/j.jpsychires.2019.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/05/2019] [Accepted: 03/01/2019] [Indexed: 12/28/2022]
Abstract
In many international studies, rates of completed suicide and suicide attempts have a seasonal pattern that peaks in spring or summer. This exploratory study investigated the association between solar insolation and a history of suicide attempt in patients with bipolar I disorder. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area on Earth. Data were collected previously from 5536 patients with bipolar I disorder at 50 collection sites in 32 countries at a wide range of latitudes in both hemispheres. Suicide related data were available for 3365 patients from 310 onset locations in 51 countries. 1047 (31.1%) had a history of suicide attempt. There was a significant inverse association between a history of suicide attempt and the ratio of mean winter solar insolation/mean summer solar insolation. This ratio is smallest near the poles where the winter insolation is very small compared to the summer insolation. This ratio is largest near the equator where there is relatively little variation in the insolation over the year. Other variables in the model that were positively associated with suicide attempt were being female, a history of alcohol or substance abuse, and being in a younger birth cohort. Living in a country with a state-sponsored religion decreased the association. (All estimated coefficients p < 0.01). In summary, living in locations with large changes in solar insolation between winter and summer may be associated with increased suicide attempts in patients with bipolar disorder. Further investigation of the impacts of solar insolation on the course of bipolar disorder is needed.
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Affiliation(s)
- Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Tasha Glenn
- ChronoRecord Association, Fullerton, CA, USA
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Ole A Andreassen
- NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elias Angelopoulos
- Department of Psychiatry, National and Capodistrian University of Athens, Medical School, Eginition Hospital, Athens, Greece
| | - Raffaella Ardau
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Yavuz Ayhan
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Christopher Baethge
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, Cologne, Germany
| | - Rita Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia
| | | | - Frank Bellivier
- Psychiatry and Addiction Medicine. Assistance Publique - Hôpitaux de Paris, INSERM UMR-S1144, Denis Diderot University, René Descartes University, FondaMental Foundation, Paris, France
| | - Robert H Belmaker
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Department of Psychiatry, Orygen, the National Centre for Excellence in Youth Mental Health, the Centre for Youth Mental Health and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Yuly Bersudsky
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | | | - Thomas D Bjella
- NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jorge Cabrera
- Mood Disorders Clinic, Dr. Jose Horwitz Psychiatric Institute, Santiago de Chile, Chile
| | - Eric Y Wo Cheung
- Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong
| | - Maria Del Zompo
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | - Seetal Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Victoria, Australia; Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Markus Donix
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bruno Etain
- Psychiatry and Addiction Medicine. Assistance Publique - Hôpitaux de Paris, INSERM UMR-S1144, Denis Diderot University, René Descartes University, FondaMental Foundation, Paris, France
| | - Andrea Fagiolini
- Department of Molecular Medicine and Department of Mental Health (DAI), University of Siena and University of Siena Medical Center (AOUS), Siena, Italy
| | - Kostas N Fountoulakis
- Division of Neurosciences, 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mark A Frye
- Department of Psychiatry & Psychology, Mayo Clinic Depression Center, Mayo Clinic, Rochester, MN, USA
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, University Hospital of Alava, University of the Basque Country, CIBERSAM, Vitoria, Spain
| | - John F Gottlieb
- Department of Psychiatry, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paul Grof
- Mood Disorders Center of Ottawa, University of Toronto, Toronto, ON, Canada
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Chantal Henry
- AP-HP, Hopitaux Universitaires Henri Mondor and INSERM U955 (IMRB) and Université Paris Est and Institut Pasteur, Unité Perception et Mémoire, Paris, France
| | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; National Institute for Health and Welfare, Helsinki, Finland
| | - Sven Janno
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - Flávio Kapczinski
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mathias Kardell
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Sebastian Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Barbara König
- BIPOLAR Zentrum Wiener Neustadt, Wiener Neustadt, Austria
| | - Timur L Kot
- Khanty-Mansiysk Clinical Psychoneurological Hospital, Khanty-Mansiysk, Russia
| | - Rikke Krogh
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Mauricio Kunz
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Mikael Landén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy, University of Gothenburg, Gothenburg and Mölndal, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Erik R Larsen
- Department of Affective Disorders, Q, Mood Disorders Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rasmus W Licht
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Carlos Lopez-Jaramillo
- Mood Disorders Program, Hospital Universitario San Vicente Fundación, Research Group in Psychiatry, Department of Psychiatry, Faculty of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Glenda MacQueen
- Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mirko Manchia
- Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada; Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Wendy Marsh
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | | | - Ingrid Melle
- NORMENT - K.G. Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Fátima Meza-Urzúa
- National Institute of Psychiatry '"Ramón de la Fuente Muñiz", Mexico City, Mexico
| | - Mok Yee Ming
- Department of General Psychiatry, Mood Disorders Unit, Institute of Mental Health, Singapore City, Singapore
| | - Scott Monteith
- Michigan State University College of Human Medicine, Traverse City Campus, Traverse City, MI, USA
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway; Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Enrica Mosca
- Section of Neurosciences and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Sardinia, Italy
| | | | - Rodrigo Munoz
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Fethi Nacef
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | | | - Fabiano G Nery
- Bipolar Disorder Research Program, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - René E Nielsen
- Unit for Psychiatric Research, Aalborg University Hospital, Psychiatry, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Claire O'Donovan
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Adel Omrani
- Tunisian Bipolar Forum, Érable Médical Cabinet 324, Lac 2, Tunis, Tunisia
| | - Yamima Osher
- Department of Psychiatry, Faculty of Health Sciences, Beer Sheva Mental Health Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Uta Ouali
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | | | - Maximilian Pilhatsch
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marco Pinna
- Lucio Bini Mood Disorder Center, Cagliari, Italy
| | - Francisco D R da Ponte
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Danilo Quiroz
- Deparment of Psychiatry, Diego Portales University, Santiago de Chile, Chile
| | - Raj Ramesar
- UCT/MRC Human Genetics Research Unit, Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Natalie Rasgon
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Palo Alto, CA, USA
| | - M S Reddy
- Asha Bipolar Clinic, Asha Hospital, Hyderabad, Telangana, India
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Philipp Ritter
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Kemal Sagduyu
- Department of Psychiatry, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Ângela M Scippa
- Department of Neuroscience and Mental Health, Federal University of Bahia, Salvador, Brazil
| | - Emanuel Severus
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | - Paul W Stackhouse
- Science Directorate/Climate Science Branch, NASA Langley Research Center, Hampton, VA, USA
| | - Dan J Stein
- Department of Psychiatry, MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Sergio Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Buenos Aires, Argentina
| | | | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kirsi Suominen
- Department of Social Services and Health Care, Psychiatry, City of Helsinki, Finland
| | - Hiromi Tagata
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Setagaya, Tokyo, Japan
| | - Yoshitaka Tatebayashi
- Schizophrenia & Affective Disorders Research Project, Tokyo Metropolitan Institute of Medical Science, Seatagaya, Tokyo, Japan
| | - Leonardo Tondo
- McLean Hospital-Harvard Medical School, Boston, MA, USA; Mood Disorder Lucio Bini Centers, Cagliari e Roma, Italy
| | - Carla Torrent
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Arne E Vaaler
- Department of Mental Health, Norwegian University of Science and Technology - NTNU, Trondheim, Norway; Department of Psychiatry, St Olavs' University Hospital, Trondheim, Norway
| | - Edgar Vares
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | | | - Maria Yoldi-Negrete
- Consejo Nacional de Ciencia y Tecnología - Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Mark Zetin
- Department of Psychology, Chapman University, Orange, CA, USA
| | - Yosra Zgueb
- Razi Hospital, Faculty of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - Peter C Whybrow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, CA, USA
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Sales AP, Santana da Silva TP, Sougey EB, Saraiva Câmara Filho JW. Psychopathological and Psychosocial Repercussions of Suicide in the Family. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666190114155014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Although the relationship between the occurrence of suicide and the
presence of psychosocial suffering in bereaved relatives is clear, there are still few studies that deal
with the detail of these repercussions and the therapeutic conduction given to them for the suicide.
Objective:
to carry out an integrative review on the psychopathological and psychosocial
repercussions of suicide in the family, with emphasis on the detail of the main psychopathological
characteristics presented by the individuals and the psychosocial impacts of mourning.
Method:
An integrative review was performed. The guiding question considered Population
Intervention Comparator Outcome Setting and the revision protocol is in agreement with Preferred
Reporting Items for Systematic Reviews and Meta-Analyzes. The search occurred in the bases:
Periodicals CAPES, PsycINFO and PubMed. Original articles were included, without language
restriction that emphasized psychopathological and psychosocial aspects of the mourners after
suicide. We excluded review studies, clinical cases, editorials and retrospectives.
Results:
The process of suicide mourning for family members is a complex event, marked by stigma
and can predispose patients to mental illness and suicidal behavior, especially in the early years of
mourning. In addition, it is necessary to expand the scope of evidence on the effectiveness of
support and intervention with this population.
Conclusion:
Bereaved families need specialized preventive support insofar as the complexity of
bereavement becomes a vulnerability factor for mental illness.
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Affiliation(s)
- Amanda Patricia Sales
- Doctorate in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
| | | | - Everton Botelho Sougey
- Doctorate in Neuropsychiatry and Behavioral Sciences, Federal University of Pernambuco, Recife, Brazil
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Reich R, Gilbert A, Clari R, Burdick KE, Szeszko PR. A preliminary investigation of impulsivity, aggression and white matter in patients with bipolar disorder and a suicide attempt history. J Affect Disord 2019; 247:88-96. [PMID: 30658245 DOI: 10.1016/j.jad.2019.01.001] [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: 08/20/2018] [Revised: 10/24/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Impulsivity and aggression may be associated with suicide attempts in bipolar disorder (BD), but findings have been inconsistent. Abnormalities in anterior white matter tracts that project to the frontal lobes mediate top-down regulation of emotion and may contribute to this clinical phenomenology. METHODS We assessed white matter (i.e., fractional anisotropy) in anterior and posterior brain regions using diffusion tensor imaging in 18 patients with BD and no prior suicide attempt (BD-S), 12 patients with BD and a prior suicide attempt (BD+S), and 12 healthy volunteers. Patients completed the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency (UPPS-P) Impulsive Behavior Scale and Impulsive Premeditated Aggression Scale (IPAS). All individuals completed the Barratt Impulsiveness Scale (BIS-11). RESULTS Patients with BD+S had higher overall impulsivity (assessed using both the UPPS-P Impulsive Behavior Scale and BIS-11) and premeditated aggression compared to patients with BD-S. There were no significant group differences on measures of fractional anisotropy (FA). In patients with BD+S, however, higher FA in the anterior (but not the posterior) brain regions correlated with greater overall impulsivity on the UPPS-P Impulsive Behavior Scale. There were no significant correlations between either anterior or posterior brain regions with clinical measures in patients with BD-S. LIMITATIONS Cross-sectional study, sample size and possible contribution of psychotropic medications. CONCLUSION Impulsivity and aggression may be risk factors for a suicide attempt in BD. White matter in the anterior limb of the internal capsule and anterior corona radiata may play a role in this phenomenology.
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Affiliation(s)
- Rachel Reich
- Yeshiva University, Ferkauf Graduate School of Psychology, Bronx, NY, USA
| | - Alison Gilbert
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Rosarito Clari
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Katherine E Burdick
- Brigham and Women's Hospital, Harvard Medical School, Department of Psychiatry, Boston MA, USA; James J. Peters VA Medical Center, Mental Health Patient Care Center and Mental Illness Research Education Clinical Center (MIRECC), Bronx, NY, USA
| | - Philip R Szeszko
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA; James J. Peters VA Medical Center, Mental Health Patient Care Center and Mental Illness Research Education Clinical Center (MIRECC), Bronx, NY, USA.
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Song J, Kuja-Halkola R, Sjölander A, Bergen SE, Larsson H, Landén M, Lichtenstein P. Specificity in Etiology of Subtypes of Bipolar Disorder: Evidence From a Swedish Population-Based Family Study. Biol Psychiatry 2018; 84:810-816. [PMID: 29331354 DOI: 10.1016/j.biopsych.2017.11.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/03/2017] [Accepted: 11/10/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Uncertainty remains whether bipolar I disorder (BDI) and bipolar II disorder (BDII) differ etiologically. We used a population-based family sample to examine the etiological boundaries between BDI and BDII by assessing their familial aggregation/coaggregation and by assessing the coaggregation between them and schizophrenia, depression, attention-deficit/hyperactivity disorder, eating disorders, autism spectrum disorder, substance use disorders, anxiety disorders, and personality disorders. METHODS By linking Swedish national registers, we established a population-based cohort (N = 15,685,511) and identified relatives with different biological relationships. Odds ratios (ORs) were used to measure the relative risk of BDI and BDII in relatives of individuals diagnosed with BDI (n = 4309) and BDII (n = 4178). The heritability for BDI and BDII and the genetic correlation across psychiatric disorders were estimated by variance decomposition analysis. RESULTS Compared with the general population, the OR of BDI was 17.0 (95% confidence interval [CI] 13.1-22.0) in first-degree relatives of BDI patients, higher than that of BDII patients (OR 9.8, 95% CI 7.7-12.5). The ORs of BDII were 13.6 (95% CI 10.2-18.2) in first-degree relatives of BDII patients and 9.8 (95% CI 7.7-12.4) in relatives of BDI patients. The heritabilities for BDI and BDII were estimated at 57% (95% CI 32%-79%) and 46% (95% CI 21%-67%), respectively, with a genetic correlation estimated as 0.78 (95% CI 0.36-1.00). The familial coaggregation of other psychiatric disorders, in particular schizophrenia, showed different patterns for BDI and BDII. CONCLUSIONS Our results suggest a distinction between BDI and BDII in etiology, partly due to genetic differences.
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Affiliation(s)
- Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Stanley Center for Psychiatric Research, the Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Hansson C, Joas E, Pålsson E, Hawton K, Runeson B, Landén M. Risk factors for suicide in bipolar disorder: a cohort study of 12 850 patients. Acta Psychiatr Scand 2018; 138:456-463. [PMID: 30076611 PMCID: PMC6220973 DOI: 10.1111/acps.12946] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Bipolar disorder carries a high risk of suicide. Identification of risk factors is important. The aim of this study was to study risk factors for suicide in a large cohort of men and women with bipolar disorder. METHOD A prospective cohort study using clinical data from the Swedish National Quality Register for Bipolar Affective Disorder (BipoläR). The outcome variable was suicide captured in the Cause of Death Register between 2004 and 2014. Hazard ratios (HR) were calculated using Cox proportional hazards models. RESULTS Of 12 850 persons (4844 men and 8006 women) with bipolar disorder, 90 (55 men and 35 women) died by suicide during the follow-up period (between 1 and 10 years). Male sex (HR 2.56), living alone (HR 2.45), previous suicide attempts (HR 4.10), comorbid psychiatric disorder (HR 2.64), recent affective episodes (HR 2.39), criminal conviction (HR 4.43), psychiatric inpatient care (HR 2.79), and involuntary commitment (HR 3.50) were significant risk factors for suicide. Several of the statistically significant risk factors for suicide in bipolar disorder differed between men and women. CONCLUSIONS Risk factors for suicide in bipolar disorder include factors associated with suicide in general, but also diagnosis-specific factors.
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Affiliation(s)
- C. Hansson
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - E. Joas
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - E. Pålsson
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - K. Hawton
- Centre for Suicide ResearchUniversity Department of PsychiatryOxfordUK
| | - B. Runeson
- Department of Clinical NeuroscienceCenter for Psychiatry ResearchKarolinska InstitutetStockholmSweden
| | - M. Landén
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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Abstract
The perinatal period is a vulnerable time for the acute onset and recurrence of psychiatric illness. Primary care providers are opportunely positioned to intervene for women who present with mood decompensation, excessive anxiety, or psychosis during the perinatal period. Owing to increased screening efforts in obstetrical clinics and amount of contact during the perinatal period, obstetricians may be able to identify patients who need treatment before their symptoms become severe. In this article, we address imminent and emergent psychiatric symptoms in the perinatal period including management and risk reduction to help obstetrician/gynecologists treat and/or refer patients as clinically appropriate.
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Affiliation(s)
- Lisette Rodriguez-Cabezas
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago
- Edward Hines Jr. VA Medical Center, Hines, Illinois
| | - Crystal Clark
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University, Chicago
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Abstract
UNLABELLED IntroductionBipolar disorder (BD) is a chronic, highly disabling condition associated with psychiatric/medical comorbidity and substantive morbidity, mortality, and suicide risks. In prior reports, varying parameters have been associated with suicide risk. OBJECTIVES To evaluate sociodemographic and clinical variables characterizing Italian individuals with BD with versus without prior suicide attempt (PSA). METHODS A sample of 362 Italian patients categorized as BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) was assessed and divided in 2 subgroups: with and without PSA. Sociodemographic and clinical variables were compared between prior attempters and non-attempters using corrected multivariate analysis of variance (MANOVA). RESULTS More than one-fourth of BD patients (26.2%) had a PSA, with approximately one-third (31%) of these having>1 PSA. Depressive polarity at onset, higher number of psychiatric hospitalizations, comorbid alcohol abuse, comorbid eating disorders, and psychiatric poly-comorbidity were significantly more frequent (p<.05) in patients with versus without PSA. Additionally, treatment with lithium, polypharmacotherapy (≥4 current drugs) and previous psychosocial rehabilitation were significantly more often present in patients with versus without PSA. CONCLUSIONS We found several clinical variables associated with PSA in BD patients. Even though these retrospective findings did not address causality, they could be clinically relevant to better understanding suicidal behavior in BD and adopting proper strategies to prevent suicide in higher risk patients.
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Malhi GS, Outhred T, Das P, Morris G, Hamilton A, Mannie Z. Modeling suicide in bipolar disorders. Bipolar Disord 2018; 20:334-348. [PMID: 29457330 DOI: 10.1111/bdi.12622] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/17/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Suicide is a multicausal human behavior, with devastating and immensely distressing consequences. Its prevalence is estimated to be 20-30 times greater in patients with bipolar disorders than in the general population. The burden of suicide and its high prevalence in bipolar disorders make it imperative that our current understanding be improved to facilitate prediction of suicide and its prevention. In this review, we provide a new perspective on the process of suicide in bipolar disorder, in the form of a novel integrated model that is derived from extant knowledge and recent evidence. METHODS A literature search of articles on suicide in bipolar disorder was conducted in recognized databases such as Scopus, PubMed, and PsycINFO using the keywords "suicide", "suicide in bipolar disorders", "suicide process", "suicide risk", "neurobiology of suicide" and "suicide models". Bibliographies of identified articles were further scrutinized for papers and book chapters of relevance. RESULTS Risk factors for suicide in bipolar disorders are well described, and provide a basis for a framework of epigenetic mechanisms, moderated by neurobiological substrates, neurocognitive functioning, and social inferences within the environment. Relevant models and theories include the diathesis-stress model, the bipolar model of suicide and the ideation-to-action models, the interpersonal theory of suicide, the integrated motivational-volitional model, and the three-step theory. Together, these models provide a basis for the generation of an integrated model that illuminates the suicidal process, from ideation to action. CONCLUSION Suicide is complex, and it is evident that a multidimensional and integrated approach is required to reduce its prevalence. The proposed model exposes and provides access to components of the suicide process that are potentially measurable and may serve as novel and specific therapeutic targets for interventions in the context of bipolar disorder. Thus, this model is useful not only for research purposes, but also for future real-world clinical practice.
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Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Tim Outhred
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Pritha Das
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Grace Morris
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Amber Hamilton
- Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.,CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Zola Mannie
- Academic Department of 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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38
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Abstract
Bipolar disease (BD) is one of the major public health burdens worldwide and more people are affected every year. Comprehensive genetic studies have associated thousands of single nucleotide polymorphisms (SNPs) with BD risk; yet, very little is known about their functional roles. Induced pluripotent stem cells (iPSCs) are powerful tools for investigating the relationship between genotype and phenotype in disease-relevant tissues and cell types. Neural cells generated from BD-specific iPSCs are thought to capture associated genetic risk factors, known and unknown, and to allow the analysis of their effects on cellular and molecular phenotypes. Interestingly, an increasing number of studies on BD-derived iPSCs report distinct alterations in neural patterning, postmitotic calcium signaling, and neuronal excitability. Importantly, these alterations are partly normalized by lithium, a first line treatment in BD. In light of these exciting findings, we discuss current challenges to the field of iPSC-based disease modelling and future steps to be taken in order to fully exploit the potential of this approach for the investigation of BD and the development of new therapies.
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Schafer M, Kim JW, Joseph J, Xu J, Frangou S, Doucet GE. Imaging Habenula Volume in Schizophrenia and Bipolar Disorder. Front Psychiatry 2018; 9:456. [PMID: 30319463 PMCID: PMC6165901 DOI: 10.3389/fpsyt.2018.00456] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/03/2018] [Indexed: 02/01/2023] Open
Abstract
The habenula (Hb), a bilateral nucleus located next to the dorsomedial thalamus, is of particular relevance to psychiatric disorders based on preclinical evidence linking the Hb to depressive and amotivational states. However, studies in clinical samples are scant because segmentation of the Hb in neuroimaging data is challenging due to its small size and low contrast from the surrounding tissues. Negative affective states dominate the clinical course of schizophrenia and bipolar disorder and represent a major cause of disability. Diagnosis-related alterations in the volume of Hb in these disorders have therefore been hypothesized but remain largely untested. To probe this question, we used a recently developed objective and reliable semi-automated Hb segmentation method based on myelin-sensitive magnetic resonance imaging (MRI) data. We ascertained case-control differences in Hb volume from high resolution structural MRI data obtained from patients with schizophrenia (n = 95), bipolar disorder (n = 44) and demographically matched healthy individuals (n = 52). Following strict quality control of the MRI data, the final sample comprised 68 patients with schizophrenia, 32 with bipolar disorder and 40 healthy individuals. Regardless of diagnosis, age, sex, and IQ were not correlated with Hb volume. This was also the case for age of illness onset and medication (i.e., antipsychotic dose and lithium-treatment status). Case-control differences in Hb volume did not reach statistical significance; their effect size (Cohen's d) was negligible on the left (schizophrenia: 0.14; bipolar disorder: -0.03) and small on the right (schizophrenia: 0.34; bipolar disorder: 0.26). Nevertheless, variability in the volume of the right Hb was associated with suicidality in the entire patient sample (ρ = 0.29, p = 0.004) as well as in each patient group (bipolar disorder: ρ = 0.34, p = 0.04; schizophrenia: ρ = 0.25, p = 0.04). These findings warrant replication in larger samples and longitudinal designs and encourage more comprehensive characterization of Hb connectivity and function in clinical populations.
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Affiliation(s)
- Matthew Schafer
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joo-Won Kim
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joshmi Joseph
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Junqian Xu
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Sophia Frangou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Gaelle E Doucet
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Kattimani S, Subramanian K, Sarkar S, Rajkumar RP, Balasubramanian S. History of Lifetime suicide attempt in bipolar I disorder: its correlates and effect on illness course. Int J Psychiatry Clin Pract 2017; 21:118-124. [PMID: 27854557 DOI: 10.1080/13651501.2016.1250912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To identify the prevalence and correlates of bipolar I patients with a lifetime history of suicide attempt. MATERIALS AND METHODS Bipolar I disorder was diagnosed in 150 patients as per DSM-IV-TR criteria. Their lifetime suicide risk was assessed using the Columbia Suicide Severity Rating Scale. NIMH retrospective Life Chart Methodology was used to chart the illness course. Medication Adherence Rating Scale (MARS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the recent adherence and subjective sleep quality, respectively. The suicide attempters were compared with non-attempters on individual variables. RESULTS Around 23% had a positive lifetime history of suicide attempt. They were predominantly female, had an index (first ever) episode of depression, spent more proportion of time being ill, especially in depressive or mixed episode phase. Comorbid substance use disorder along with suicidal attempts was seen only in males. Suicide attempters displayed poor medication adherence attitudes for medications taken during the past week and reported impaired sleep quality for the previous month. CONCLUSIONS A positive history of lifetime suicide attempt was significantly associated with a worse course of bipolar I disorder. Effective treatment of depressive episodes, addressing non-adherence, substance use and sleep problems can reduce the suicide risk in such patients. Retrospective design of the study and recall bias are some of the limitations.
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Affiliation(s)
- Shivanand Kattimani
- a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India
| | - Karthick Subramanian
- a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India
| | - Siddharth Sarkar
- b Department of Psychiatry , All India Institute of Medical Sciences , New Delhi , India
| | - Ravi Philip Rajkumar
- a Department of Psychiatry , Jawaharlal Institute of Post Graduate Medical Education and Research , Puducherry , India
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Kalankesh LR, Farahbakhsh M, Fein RA, Moftian N, Nasiry Z. Exploring Complexity of Deliberate Self-Poisoning through Network Analysis. PSYCHIATRY JOURNAL 2017; 2017:3619721. [PMID: 28251146 PMCID: PMC5303583 DOI: 10.1155/2017/3619721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/20/2016] [Accepted: 12/05/2016] [Indexed: 01/20/2023]
Abstract
The purpose of this research was to examine the complexity of circumstances that result in deliberate self-poisoning cases. For the purposes of this paper, the cases were patients that presented for care and were admitted to the specialty hospital in Northwest of Iran. The research examined the problems preceding deliberate self-poisoning and the interrelations among them by applying network analysis methods. The network was scored for degrees of centrality and betweenness centrality. Structural analysis of network also was conducted using block modelling. The results showed that family conflicts had the highest score for degree of centrality among women, while the highest score for degree of centrality among men belonged to those dealing with drug addiction. Analysis for degree of betweenness centrality revealed that drug addiction had the highest score among men, whereas the highest score for women on betweenness centrality was related to physical illness. Structural analysis of the network showed differences in role that various problems played in intentional self-poisoning. The findings from this research can be used by public health authorities to create prevention programs that address the problems leading to deliberate self-poisoning.
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Affiliation(s)
- Leila R. Kalankesh
- Tabriz Health Services Management Research Center, Tabriz, Iran
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mostafa Farahbakhsh
- Tabriz Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rebecca A. Fein
- Laboratory Informatics Institute, Smyrna, GA, USA
- National Alliance of Research Associates Programs (NARAP), Hartford, CT, USA
| | - Nazila Moftian
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Nasiry
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Bezerra S, Galvão-de-Almeida A, Studart P, Martins DF, Caribé AC, Schwingel PA, Miranda-Scippa Â. Suicide attempts in bipolar I patients: impact of comorbid personality disorders. ACTA ACUST UNITED AC 2017; 39:133-139. [PMID: 28076649 PMCID: PMC7111445 DOI: 10.1590/1516-4446-2016-1982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/27/2016] [Indexed: 11/22/2022]
Abstract
Objective To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD). Methods One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics. Results History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis. Conclusions Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.
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Affiliation(s)
- Severino Bezerra
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil
| | - Amanda Galvão-de-Almeida
- Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.,Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
| | - Paula Studart
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil
| | - Davi F Martins
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil
| | - André C Caribé
- Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.,Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil
| | - Paulo A Schwingel
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.,Departamento de Nutrição, Universidade de Pernambuco (UPE), Petrolina, PE, Brazil
| | - Ângela Miranda-Scippa
- Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.,Programa de Avaliação Continuada do Centro de Estudos de Transtornos de Humor e Ansiedade (CETHA), Hospital Universitário Professor Edgard Santos, UFBA, Salvador, BA, Brazil.,Departamento de Neurociências e Saúde Mental, Faculdade de Medicina, UFBA, Salvador, BA, Brazil
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Jun-O’Connell AH, Butala A, Morales IB, Henninger N, Deligiannidis KM, Byatt N, Ionete C. The Prevalence of Bipolar Disorders and Association With Quality of Life in a Cohort of Patients With Multiple Sclerosis. J Neuropsychiatry Clin Neurosci 2017; 29:45-51. [PMID: 27539374 PMCID: PMC5288280 DOI: 10.1176/appi.neuropsych.15120403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical observations of mood instability in multiple sclerosis (MS) have led to the hypothesis that bipolar disorder (BD) may be more prevalent in persons with MS than in the general population. This cross-sectional study assesses the prevalence of BD among patients with MS using standardized psychiatric diagnostic interviews and evaluates quality of life. This study demonstrates a higher prevalence of BD in patients with MS compared with the general population. It also reveals the negative impact of BD on quality of life, raises the concern that BD can occur before the onset of neurological symptoms in MS, and suggests that, in some cases, BD may delay diagnosis of MS.
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Studart P, Galvão-de Almeida A, Bezerra-Filho S, Caribé A, Reis Afonso N, Daltro C, Miranda-Scippa Â. Is history of suicidal behavior related to social support and quality of life in outpatients with bipolar I disorder? Psychiatry Res 2016; 246:796-802. [PMID: 28029441 DOI: 10.1016/j.psychres.2016.10.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022]
Abstract
Bipolar disorder (BD) affects the social functioning and quality of life (QoL) of its patients. This study aimed to investigate whether there is an association between social support (SS), and suicidal behavior in BD I patients compared to healthy controls; secondarily, we evaluated the influence of QoL on those variables. A total of 119 euthymic outpatients with BD I, 46 of whom had attempted suicide (SAs) and 73 who had not (non-SAs), were compared to 63 healthy controls, through the Medical Outcomes Study Social Support Scale and World Health Organization's Quality of Life Instrument. No differences were noted in SS and QoL between SAs and non-SAs. Compared to healthy controls, non-SAs showed lower values in the positive social interaction domain of SS, and the patients, as a whole, showed lower values in affectionate and positive social interaction domains of SS. Compared to healthy controls, SAs had lower values in the environmental domain of QoL, and the patients, as a whole, had lower values in the environmental, social, and psychological domains of QoL. There was positive correlation between SS and QoL. Although BD is a disabling disease, patients receive inadequate SS. Interventions that may alter the SS in these patients should be investigated.
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Affiliation(s)
- Paula Studart
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil.
| | - Amanda Galvão-de Almeida
- Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil; Department of Neurosciences and Mental Health, Medical School, Federal University of Bahia, Salvador, BA, Brazil
| | - Severino Bezerra-Filho
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil
| | - André Caribé
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil; Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | | | - Carla Daltro
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Bahiana School of Medicine and Public Health, Salvador, BA, Brazil
| | - Ângela Miranda-Scippa
- Medicine and Health Postgraduate Program, Federal University of Bahia, Salvador, BA, Brazil; Program of Mood and Anxiety Disorders (CETHA), Federal University of Bahia, Salvador, BA, Brazil; Department of Neurosciences and Mental Health, Medical School, Federal University of Bahia, Salvador, BA, Brazil
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Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990-2015: Systematic review and meta-analysis. J Affect Disord 2016; 206:331-349. [PMID: 27476137 DOI: 10.1016/j.jad.2016.07.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/09/2016] [Accepted: 07/03/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings. METHODS A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users. LIMITATIONS The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred. CONCLUSIONS This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD.
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Affiliation(s)
- Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
| | - Gin S Malhi
- Discipline of Psychiatry and CADE Clinic, Royal North Shore Hospital, University of Sydney, NSW, Australia.
| | - Michelle Cleary
- School of Health Sciences, University of Tasmania, Sydney, NSW, Australia.
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Sajatovic M, Ng-Mak D, Solem CT, Lin FJ, Rajagopalan K, Loebel A. Dosing patterns and medication adherence in bipolar disorder patients treated with lurasidone: a US retrospective claims database analysis. Ther Adv Psychopharmacol 2016; 6:355-368. [PMID: 28008349 PMCID: PMC5167084 DOI: 10.1177/2045125316672135] [Citation(s) in RCA: 10] [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] Open
Abstract
BACKGROUND The aim of this study was to describe dosing patterns and medication adherence among bipolar patients who initiated lurasidone in a real-world setting. METHODS Adult bipolar patients who initiated lurasidone between 1 November 2010 and 31 December 2012 (index period) with 6-month pre- and post-index continuous enrollment were identified from the IMS RWD Adjudicated Claims US database. Patients were grouped by starting lurasidone daily dose: 20 mg (7.1%), 40 mg (62.2%), 60-80 mg (28.7%), and 120-160 mg (2.1%). Patient characteristics were compared across doses using Cochran-Armitage trend tests. Multivariable ordinal logistic regression assessed the association between initial lurasidone dose and patient characteristics. Medication adherence was measured using medication possession ratio (MPR). RESULTS Of 1114 adult bipolar patients (mean age 40.6 years, 70.6% female), 90% initiated lurasidone at 40 mg or 80 mg/day (mean 51.9 mg/day). Of these, 16.2% initiated lurasidone as monotherapy. Mean lurasidone maintenance dose was 55.2 mg/day and mean MPR was 0.53 [standard deviation (SD) = 0.34] over the 6-month follow up. Substance use, hyperglycemia, obesity, and prior antipsychotic use were associated with higher initial lurasidone doses (p < 0.05). Odds of a 20 mg/day increase in initial lurasidone dose was 1.6-times higher for patients with substance use [95% confidence interval (CI): 1.16-2.24], 2.6-times higher with hyperglycemia problems (95% CI: 1.15-5.83), 1.7-times higher with obesity (95% CI: 1.05-2.60), and 1.3 (95% CI: 1.01-1.78) and 1.8-times higher (95% CI: 1.17-2.86) with prior use of second- and first-generation antipsychotics, respectively. CONCLUSIONS This real-world analysis of bipolar patients indicated that 40 mg or 80 mg/day were the most common starting doses of lurasidone. A majority of patients used concomitant psychiatric medications (polypharmacy). Higher doses of lurasidone were prescribed to patients with comorbidities or prior antipsychotic use. Adherence to lurasidone was comparable to or better than antipsychotic adherence reported in bipolar disorder literature.
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Affiliation(s)
- Martha Sajatovic
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daisy Ng-Mak
- Sunovion Pharmaceuticals Inc., Global Health Economics & Health Outcomes Research, 84 Waterford Drive, Marlborough, MA 01752, USA
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Abstract
Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment. Regardless of whether an individual crosses an arbitrary diagnostic threshold, a considerable proportion of young people with borderline- and mood-related psychopathology will develop significant and persistent functional, vocational, and interpersonal impairment and disability during this critical risk and developmental period. There is a clear need for early intervention, but spurious diagnostic certainty risks stigma, misapplication of diagnostic labels, inappropriate treatment, and unfavorable outcomes. This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. "Clinical staging," similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual's location along the continuum of the evolving temporal course of a disorder. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression and chronicity, and suggests the application of appropriate and proportionate intervention strategies.
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Genome-wide association study identifies SESTD1 as a novel risk gene for lithium-responsive bipolar disorder. Mol Psychiatry 2016; 21:1290-7. [PMID: 26503763 PMCID: PMC4995544 DOI: 10.1038/mp.2015.165] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 09/24/2015] [Indexed: 12/02/2022]
Abstract
Lithium is the mainstay prophylactic treatment for bipolar disorder (BD), but treatment response varies considerably across individuals. Patients who respond well to lithium treatment might represent a relatively homogeneous subtype of this genetically and phenotypically diverse disorder. Here, we performed genome-wide association studies (GWAS) to identify (i) specific genetic variations influencing lithium response and (ii) genetic variants associated with risk for lithium-responsive BD. Patients with BD and controls were recruited from Sweden and the United Kingdom. GWAS were performed on 2698 patients with subjectively defined (self-reported) lithium response and 1176 patients with objectively defined (clinically documented) lithium response. We next conducted GWAS comparing lithium responders with healthy controls (1639 subjective responders and 8899 controls; 323 objective responders and 6684 controls). Meta-analyses of Swedish and UK results revealed no significant associations with lithium response within the bipolar subjects. However, when comparing lithium-responsive patients with controls, two imputed markers attained genome-wide significant associations, among which one was validated in confirmatory genotyping (rs116323614, P=2.74 × 10(-8)). It is an intronic single-nucleotide polymorphism (SNP) on chromosome 2q31.2 in the gene SEC14 and spectrin domains 1 (SESTD1), which encodes a protein involved in regulation of phospholipids. Phospholipids have been strongly implicated as lithium treatment targets. Furthermore, we estimated the proportion of variance for lithium-responsive BD explained by common variants ('SNP heritability') as 0.25 and 0.29 using two definitions of lithium response. Our results revealed a genetic variant in SESTD1 associated with risk for lithium-responsive BD, suggesting that the understanding of BD etiology could be furthered by focusing on this subtype of BD.
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Hughes T, Hansson L, Sønderby IE, Athanasiu L, Zuber V, Tesli M, Song J, Hultman CM, Bergen SE, Landén M, Melle I, Andreassen OA, Djurovic S. A Loss-of-Function Variant in a Minor Isoform of ANK3 Protects Against Bipolar Disorder and Schizophrenia. Biol Psychiatry 2016; 80:323-330. [PMID: 26682468 DOI: 10.1016/j.biopsych.2015.09.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/10/2015] [Accepted: 09/24/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankyrin-3 (ANK3) was one of the first genes to reach significance in a bipolar disorder genome-wide association study. Many subsequent association studies confirmed this finding and implicated this gene in schizophrenia. However, the exact nature of the role of ANK3 in the pathophysiology remains elusive. In particular, the specific isoforms involved and the nature of the imbalance are unknown. METHODS We genotyped a Norwegian sample of 402 patients with bipolar disorder, 293 patients with schizophrenia, and 330 healthy control subjects genome-wide with the Illumina Human Exome BeadChip. We performed allelic association tests at the genome-wide and gene levels and found a significantly associated single nucleotide polymorphism in a splice site of ANK3. We replicated this finding in two other samples and studied the functional effect of this single nucleotide polymorphism by performing quantitative polymerase chain reaction on the affected exon junction in complementary DNA from blood total RNA. RESULTS The splice site single nucleotide polymorphism (rs41283526) is located in an alternatively spliced exon of ANK3 and has a strong and significant protective effect against bipolar disorder (odds ratio = .31) and schizophrenia (odds ratio = .21). The minor allele of rs41283526 is a loss-of-function variant that disables the correct splicing of the transcript. Data from the BrainSpan human developmental transcriptome show that the exon bearing this variant is expressed only in a minor isoform of ANK3, the transcription of which is initiated in early adolescence. CONCLUSIONS Our results suggest that an elevated expression of this transcript starting in adolescence may be an important factor in the pathophysiology of schizophrenia and bipolar disorder.
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Affiliation(s)
- Timothy Hughes
- Department of Medical Genetics, Oslo; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo.
| | - Lars Hansson
- Department of Medical Genetics, Oslo; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Ida E Sønderby
- Department of Medical Genetics, Oslo; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Lavinia Athanasiu
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Verena Zuber
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo; Prostate Cancer Research Group, Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo and Oslo University Hospital, Oslo
| | - Martin Tesli
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo
| | - Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Christina M Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital, Oslo; NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Srdjan Djurovic
- Department of Medical Genetics, Oslo; NORMENT, KG Jebsen Centre for Psychosis Research, Department of Clinical Science, University of Bergen, Bergen, Norway
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Hou L, Bergen SE, Akula N, Song J, Hultman CM, Landén M, Adli M, Alda M, Ardau R, Arias B, Aubry JM, Backlund L, Badner JA, Barrett TB, Bauer M, Baune BT, Bellivier F, Benabarre A, Bengesser S, Berrettini WH, Bhattacharjee AK, Biernacka JM, Birner A, Bloss CS, Brichant-Petitjean C, Bui ET, Byerley W, Cervantes P, Chillotti C, Cichon S, Colom F, Coryell W, Craig DW, Cruceanu C, Czerski PM, Davis T, Dayer A, Degenhardt F, Del Zompo M, DePaulo JR, Edenberg HJ, Étain B, Falkai P, Foroud T, Forstner AJ, Frisén L, Frye MA, Fullerton JM, Gard S, Garnham JS, Gershon ES, Goes FS, Greenwood TA, Grigoroiu-Serbanescu M, Hauser J, Heilbronner U, Heilmann-Heimbach S, Herms S, Hipolito M, Hitturlingappa S, Hoffmann P, Hofmann A, Jamain S, Jiménez E, Kahn JP, Kassem L, Kelsoe JR, Kittel-Schneider S, Kliwicki S, Koller DL, König B, Lackner N, Laje G, Lang M, Lavebratt C, Lawson WB, Leboyer M, Leckband SG, Liu C, Maaser A, Mahon PB, Maier W, Maj M, Manchia M, Martinsson L, McCarthy MJ, McElroy SL, McInnis MG, McKinney R, Mitchell PB, Mitjans M, Mondimore FM, Monteleone P, Mühleisen TW, Nievergelt CM, Nöthen MM, Novák T, Nurnberger JI, Nwulia EA, Ösby U, Pfennig A, Potash JB, Propping P, Reif A, Reininghaus E, Rice J, Rietschel M, Rouleau GA, Rybakowski JK, Schalling M, Scheftner WA, Schofield PR, Schork NJ, Schulze TG, Schumacher J, Schweizer BW, Severino G, Shekhtman T, Shilling PD, Simhandl C, Slaney CM, Smith EN, Squassina A, Stamm T, Stopkova P, Streit F, Strohmaier J, Szelinger S, Tighe SK, Tortorella A, Turecki G, Vieta E, Volkert J, Witt SH, Wright A, Zandi PP, Zhang P, Zollner S, McMahon FJ. Genome-wide association study of 40,000 individuals identifies two novel loci associated with bipolar disorder. Hum Mol Genet 2016; 25:3383-3394. [PMID: 27329760 PMCID: PMC5179929 DOI: 10.1093/hmg/ddw181] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/23/2016] [Accepted: 06/09/2016] [Indexed: 12/31/2022] Open
Abstract
Bipolar disorder (BD) is a genetically complex mental illness characterized by severe oscillations of mood and behaviour. Genome-wide association studies (GWAS) have identified several risk loci that together account for a small portion of the heritability. To identify additional risk loci, we performed a two-stage meta-analysis of >9 million genetic variants in 9,784 bipolar disorder patients and 30,471 controls, the largest GWAS of BD to date. In this study, to increase power we used ∼2,000 lithium-treated cases with a long-term diagnosis of BD from the Consortium on Lithium Genetics, excess controls, and analytic methods optimized for markers on the X-chromosome. In addition to four known loci, results revealed genome-wide significant associations at two novel loci: an intergenic region on 9p21.3 (rs12553324, P = 5.87 × 10 - 9; odds ratio (OR) = 1.12) and markers within ERBB2 (rs2517959, P = 4.53 × 10 - 9; OR = 1.13). No significant X-chromosome associations were detected and X-linked markers explained very little BD heritability. The results add to a growing list of common autosomal variants involved in BD and illustrate the power of comparing well-characterized cases to an excess of controls in GWAS.
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Affiliation(s)
- Liping Hou
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Nirmala Akula
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA
| | - Jie Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christina M Hultman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Raffaella Ardau
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Bárbara Arias
- Department of Biologia Animal, Unitat d'Antropologia (Dp. Biología Animal), Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Mood Disorders Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Lena Backlund
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Judith A Badner
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | | | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Bernhard T Baune
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Frank Bellivier
- INSERM UMR-S 1144 - Université Paris Diderot. Pôle de Psychiatrie, AP-HP, Groupe Hospitalier Lariboisière-F. Widal, Paris, France
| | - Antonio Benabarre
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Susanne Bengesser
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Wade H Berrettini
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Joanna M Biernacka
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Armin Birner
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | | | - Clara Brichant-Petitjean
- INSERM UMR-S 1144 - Université Paris Diderot. Pôle de Psychiatrie, AP-HP, Groupe Hospitalier Lariboisière-F. Widal, Paris, France
| | - Elise T Bui
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA
| | - William Byerley
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA, USA
| | - Pablo Cervantes
- McGill University Health Centre, Mood Disorders Program, Montreal, QC, Canada
| | - Caterina Chillotti
- Unit of Clinical Pharmacology, Hospital University Agency of Cagliari, Cagliari, Italy
| | - Sven Cichon
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
- Division of Medical Genetics and Department of Biomedicine, University of Basel, Switzerland
| | - Francesc Colom
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - William Coryell
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - David W Craig
- The Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Cristiana Cruceanu
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Piotr M Czerski
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Tony Davis
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, Mood Disorders Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Maria Del Zompo
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bruno Étain
- INSERM U955, Psychiatrie translationnelle, Université Paris Est Créteil, Pôle de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Louise Frisén
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry Research Center, Stockholm, Sweden
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Janice M Fullerton
- Psychiatric Genetics, Neuroscience Research Australia, Sydney, Australia
- School of Medical Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Sébastien Gard
- Service de Psychiatrie, Hôpital Charles Perrens, Bordeaux, France
| | - Julie S Garnham
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Elliot S Gershon
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Fernando S Goes
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Tiffany A Greenwood
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Maria Grigoroiu-Serbanescu
- Biometric Psychiatric Genetics Research Unit, Alexandru Obregia Clinical Psychiatric Hospital, Bucharest, Romania
| | - Joanna Hauser
- Psychiatric Genetic Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University Göttingen, Göttingen, Germany
| | - Stefanie Heilmann-Heimbach
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Stefan Herms
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Division of Medical Genetics and Department of Biomedicine, University of Basel, Switzerland
| | - Maria Hipolito
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | | | - Per Hoffmann
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
- Division of Medical Genetics and Department of Biomedicine, University of Basel, Switzerland
| | - Andrea Hofmann
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Stephane Jamain
- INSERM U955, Psychiatrie translationnelle, Université Paris Est Créteil, Pôle de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Esther Jiménez
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Jean-Pierre Kahn
- Service de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy - Université de Lorraine, Nancy, France
| | - Layla Kassem
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA
| | - John R Kelsoe
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sarah Kittel-Schneider
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Sebastian Kliwicki
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Daniel L Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Barbara König
- Department of Psychiatry and Psychotherapeuthic Medicine, Landesklinikum Neunkirchen, Neunkirchen, Austria
| | - Nina Lackner
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Gonzalo Laje
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA
| | - Maren Lang
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - William B Lawson
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | - Marion Leboyer
- INSERM U955, Psychiatrie translationnelle, Université Paris Est Créteil, Pôle de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Susan G Leckband
- Department of Pharmacy, VA San Diego Healthcare System, San Diego, CA, USA
| | - Chunyu Liu
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Anna Maaser
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Pamela B Mahon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Mirko Manchia
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Lina Martinsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Michael J McCarthy
- Department of Psychiatry, VA San Diego Healthcare System, San Diego, CA, USA
| | - Susan L McElroy
- Lindner Center of HOPE, University of Cincinnati College of Medicine, Mason, OH, USA
| | - Melvin G McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca McKinney
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Marina Mitjans
- Department of Biologia Animal, Unitat d'Antropologia (Dp. Biología Animal), Facultat de Biologia and Institut de Biomedicina (IBUB), Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Francis M Mondimore
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Palmiero Monteleone
- Department of Psychiatry, University of Naples SUN, Naples, Italy
- Neurosciences Section, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Thomas W Mühleisen
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Centre Jülich, Germany
| | | | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Tomas Novák
- National Institute of Mental Health, Klecany, Czech Republic
| | - John I Nurnberger
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evaristus A Nwulia
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | - Urban Ösby
- Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - James B Potash
- Department of Psychiatry, Carver College of Medicine, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Peter Propping
- Institute of Human Genetics, University of Bonn, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Eva Reininghaus
- Special Outpatient Center for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - John Rice
- Department of Psychiatry, Washington University School of Medicine in St. Louis
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Martin Schalling
- Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Peter R Schofield
- School of Medical Sciences, University of New South Wales, Sydney, NSW, 2052, Australia
- Mental Illness, Neuroscience Research Australia, Sydney, Australia
| | | | - Thomas G Schulze
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Institute of Psychiatric Phenomics and Genomics, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August University Göttingen, Göttingen, Germany
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Schumacher
- Institute of Human Genetics, University of Bonn, Germany
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - Barbara W Schweizer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Giovanni Severino
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Paul D Shilling
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Claire M Slaney
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Erin N Smith
- Scripps Translational Science Institute, La Jolla, CA, USA
| | - Alessio Squassina
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Pavla Stopkova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Fabian Streit
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jana Strohmaier
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Sarah K Tighe
- Department of Psychiatry, Carver College of Medicine, University of Iowa School of Medicine, Iowa City, IA, USA
| | | | - Gustavo Turecki
- Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Eduard Vieta
- Bipolar Disorder Program, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Julia Volkert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Adam Wright
- School of Psychiatry, University of New South Wales, and Black Dog Institute, Sydney, Australia
| | - Peter P Zandi
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Peng Zhang
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sebastian Zollner
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Francis J McMahon
- Intramural Research Program, National Institute of Mental Health, National Institutes of Health,U.S. Department of Health & Human Services, Bethesda, MD, USA,
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