Bipolar Disorder and Suicide: a Review

Construction and verification of risk prediction model for suicidal attempts of mood disorder based on machine learning

BACKGROUND

Mood disorders (MD) are closely related to suicide attempt (SA). Developing an effective prediction model for SA in MD patients could play a crucial role in the early identification of high-risk groups.

METHODS

1099 patients with MD were collected to Model construction. 387 MD patients were enrolled for external validate. The least absolute shrinkage and selection operator (LASSO) regression was used to screen features that may be related to SA as predictors. Ten machine learning algorithms were applied to the training set to construct the SA prediction model. The machine learning model with the best sensitivity and stability was selected according to AUC, F1 score, accuracy and other indicators. The locally explanatory technique of Shapley Additive Explanations (SHAP) was used to rank and interpret the importance of features collected in best model to analyze the potential impact of each feature on SA. Meanwhile, to further validate the stability of the model, the sensitivity analysis utilizing k-fold cross-validation and external validate in another center were performed.

RESULTS

This study incorporates 8 features. Prediction models was constructed based on 10 different machine learning methods. The results showed that the prediction model constructed by Random Forest (RF) method had good discriminant ability and stability (AUC of Testing = 0.741, AUC of Training = 0.786, AUC of validation = 0.788) and acceptable discriminant. Further, the prediction model showed that the most valuable features for predicting SA were Polarity and previous SA.

CONCLUSION

The RF method can better construct the risk prediction model of SA in MD patients.

Real-world Effectiveness and Tolerability of Lurasidone in Outpatients with Bipolar DisorderII- A 24 week retrospective study (RETLO-BDIIstudy)

OBJECTIVES

We conducted a retrospective study to investigate the efficacy and safety of lurasidone (LUR) in outpatients with depressive episodes of bipolar disorder II (BD2) in real world setting.

METHODS

We retrospectively analyzed the clinical data obtained from the medical records of the Horikoshi Psychosomatic Clinic between February 2020 and April 2022. A total of 78 patients with BD2 who experienced a depressive episode were included in this study. The primary outcome was the mean change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score from baseline to 8 weeks (W). The secondary outcome was the mean change in the MADRS score from baseline to 2, 4, and 12 W. Discontinuation and adverse event rates were measured after 24 W.

RESULTS

After starting LUR, the mean total score of the MADRS significantly decreased at 8 W (-11.8 ± 8.26, P < 0.0001). Patients with BD2 who underwent the treatment with LUR showed significantly great improvement at 2 W (-8.38 ± 8.75, P< 0.0001), 4 W (-11.2 ± 8.36 P < 0.0001), and 24 W (-11.6 ± 7.29, P < 0.0001). The discontinuation and adverse event rates in patients who underwent LUR were 23.1 % and 37.2 %, respectively.

CONCLUSION

LUR significantly improved depressive symptoms in patients with BD2 at 8 W. Moreover, treatment with LUR resulted in early improvement at 2 W and efficacy for 24 weeks. In summary, LUR demonstrated effectiveness and safety in acute depressive episodes of BD2, including mid-term efficacy in real-world clinical settings.

Is Theta Burst Stimulation Ready as a Clinical Treatment for Bipolar Disorder?

BACKGROUND

To date, no studies have investigated the efficacy of theta burst stimulation (TBS) in the treatment of bipolar disorder (BD), and the results are inconclusive.

OBJECTIVE

We aim to systematically review the existing literature related to the efficacy of TBS in BD and synthesize the results through meta-analysis.

METHODS

We searched for PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of science, PsycINFO, CNKI, and Wan fang databases without language restriction through July 30, 2023, and included randomized-controlled trials that assessed the treatment effect of TBS in patients with BD. We used a random-effects model to pool effect sizes, which were expressed as Cohen's d (or Odds ratio) and 95% confidence intervals (CIs). The outcome measures include changes in Montgomery-Asberg Depression Rating Scale (MADRS) scores, response and remission rates of depression, and dropout rates.

RESULT

Eight randomized sham-controlled trials were included in the meta-analysis. The overall effect size of the outcome measures, including changes in MARDS scale scores, response rate, and remission rates, were -0.81 (95% confidence interval [CI]: 4.07 to 2.44), 1.07 (95% CI: 0.47 to 2.44) and 0.74 (95% CI: 0.38 to 1.45), respectively. Notably, the TBS group showed favorable efficacy without major adverse events.

CONCLUSION

Current studies indicate that TBS does not show significant antidepressant efficacy in patients with BD, although it is very well tolerated.

Cannabis and tobacco use in bipolar disorder: Associations with early onset, psychotic symptoms, and relapse risk (2015-2019)

BACKGROUND

Substance use disorders (SUD) frequently occur alongside bipolar disorder (BD), with some studies indicating a 29 % comorbidity rate in Western populations [1]. The relationship between BD and SUD is intricate and bidirectional - drug misuse can increase the risk of developing BD, and individuals with BD have a higher risk of developing SUD. This complex interplay often leads to earlier BD onset, more hospitalizations, and reduced effectiveness of pharmacological treatments, particularly mood stabilizers. This work aims to describe the impact of drugs in the risk of relapse in BD and to approach the differences in the evolution in substance users compared to non-users.

METHODS

We conducted a prospective cohort study including the patients admitted to Hospital Clínic of Barcelona acute psychiatric unit with the diagnosis of manic or mixed episode during the period between 2015 and 2019. We established a follow-up of 3 years from the date of admission in which hospital readmissions are examined.

RESULTS

The study, which included 279 patients, concluded that only tobacco users showed significantly higher rates of emergency room (ER) visits and hospital readmissions in the period study, while cannabis was only associated with earlier onset of illness, current manic polarity, the presence of psychotic symptoms and a higher likelihood of discontinuing treatment. Alcohol, cocaine and stimulants did not appear to have an association with the variables studied.

LIMITATIONS

Lack of follow-up information from people leaving the region or changing to private sector services, lack of detailed information around the pattern and history of consumption.

CONCLUSIONS

Tobacco seemed to have a clear negative association with the course of the illness. Cannabis, while its use was not associated with the relapse rate, was indirectly associated with variables suggesting a more severe symptomatology and a possible qualitatively different course of illness. More evidence is needed to define the mechanisms and patterns related to these effects.

Emotional memory biases in bipolar depressed patients with high suicide risk

Emotional memory bias, a neurocognitive deficit commonly observed in mood disorders, refers to the tendency to remember emotionally charged information more precisely than healthy individuals. While this phenomenon has been explored in various psychiatric conditions, its specific relationship with suicide risk in patients with bipolar disorder during major depressive episodes remains unknown. Given the high prevalence of suicide in bipolar disorder, this study sought to examine the association between emotional memory bias and suicide risk in patients with bipolar depression. A recognition memory task was utilized, where participants (51 high-risk, 21 low-risk) viewed words with positive or negative valence and later identified whether they had been previously presented. Mixed-model analyses of covariance, controlling for age and depression severity, revealed that the high-risk group demonstrated a stronger bias toward negative stimuli. They exhibited more accurate recognition of negative words ("hits") and a higher tendency to incorrectly identify non-presented negative words as presented ("false alarms") compared to the low-risk group. These findings suggest that heightened emotional memory bias, particularly toward negative information, may be a key cognitive marker of suicide risk in patients with bipolar depression. Understanding this bias may inform targeted interventions aimed at reducing suicide risk in this population.

Serum BDNF, depressive symptoms, sleep quality, and cognitive function: a study on their impact and predictive value for suicidal ideation in bipolar depressive disorder patients

OBJECTIVE

This study aims to investigate the factors influencing suicidal ideation in patients with bipolar depressive disorder (BDD), focusing primarily on cognitive function, brain-derived neurotrophic factor (BDNF), sleep quality, and depressive symptoms.

METHODS

A total of 126 patients with depressive episodes of bipolar disorder and 38 healthy controls were recruited for this study. Participants were divided into suicidal ideation and non-suicidal ideation groups based on the Beck Scale for Suicide Ideation-Chinese Version (BSI-CV). Depressive symptoms were assessed using the 24-item Hamilton Rating Scale for Depression (HAMD-24), and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Cognitive function was measured using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB), and serum BDNF levels were determined.

RESULTS

24.6% of the patients exhibited suicidal ideation. High depression scores and poor sleep quality were identified as risk factors, whereas good cognitive function and higher levels of BDNF served as protective factors. Receiver Operating Characteristic (ROC) analysis revealed that serum BDNF, depressive symptoms, sleep quality, and cognitive function have significant predictive value, with a combined use of these four indicators yielding even better predictive results.

CONCLUSION

Serum BDNF levels, depression scores, sleep quality scores, and cognitive function scores can be used as predictive indicators for suicidal ideation in BDD patients. The combined use of these four indicators provides optimal predictive efficacy.

Abnormal network homogeneity in patients with bipolar disorder in attention network

Bipolar disorder (BD) is a complex psychiatric condition marked by significant mood fluctuations that deeply affect quality of life. Understanding the neural mechanisms underlying BD is critical for improving diagnostic accuracy and developing more effective treatments. This study utilized resting-state functional magnetic resonance imaging (rs-fMRI) to investigate functional connectivity within the ventral and dorsal attention networks in 52 patients with BD and 51 healthy controls. Independent Component Analysis (ICA) was employed to establish network templates, while Network Homogeneity (NH) analysis facilitated the comparison of NH values across various brain regions. We examined the association of NH values with clinical measures, including the Hamilton Depression Scale, Perceptual Deficit Questionnaire, and Young Mania Scale. Results indicated that BD patients exhibited lower NH values in the right inferior temporal gyrus of the dorsal attention network and the right middle temporal gyrus of the ventral attention network compared to controls. Notably, NH values in the right superior marginal gyrus of the ventral network were higher in the BD group. Although no significant correlations were found between NH values and clinical symptoms, Support Vector Machine (SVM) analysis demonstrated over 60% accuracy in differentiating BD patients based on NH values. These findings highlight the potential of NH measures as biomarkers for BD, underscore the importance of advanced neuroimaging in uncovering the disorder's complex neural dynamics, and point to the challenges and need for further research to improve predictive accuracy.

Symptom Severity and Treatment Needs Among Racial Groups Seeking Treatment at a Mood Outcomes Program

Mood disorders are highly prevalent. Despite increased rates of treatment provision, treatment gaps are sustained by inadequate targeting of interventions and little emphasis on prevention. Here, the authors present an overview and analysis of the National Network of Depression Centers (NNDC) Mood Outcomes Program, which is both a measurement-based care program, with a standardized set of mood "vital signs" assessed as part of routine clinical care, and a learning health system. The authors analyzed all data collected since the program's inception in 2015 to assess whether baseline symptom severity, prior suicidal ideation or attempts, length of care, and longitudinal symptom severity differed across sociodemographic groups. The results show important treatment needs that are not being fulfilled. Most notably, the groups with the greatest symptom severity were not the groups with the most visits. Efforts to address systemic barriers that prevent access to mental health care are required. Given that the NNDC Mood Outcomes Program is integrated with clinical care, academic programs, and research at each site, the authors anticipate that the program is well suited to support efforts to dismantle systemic barriers to care.

A national survey of suicidality and non-suicidal self-injury in bipolar disorder: insights from network analysis

BACKGROUND

There is a high prevalence of suicidal ideation (SI), suicide attempts (SA), and non-suicidal self-injury (NSSI) in bipolar disorder (BD). Understanding the nature of suicidality and NSSI in BD is an important way to inform optimal intervention for reducing suicide risk. We aimed to investigate the prevalence and correlates of SI, SA, and NSSI in patients with BD using data from a national survey. We used network analysis to explore the associations among suicidality, NSSI, addictive features of NSSI, and symptoms of BD.

METHODS

Participants with BD were recruited from 20 research centers in China. Suicidality, NSSI, addictive features, and symptoms of BD were measured via a standardized electronic case report form. We used logistic regression and network analysis for data analysis.

RESULTS

Of the 1,055 participants recruited, over 50% with depressive or mixed episodes had SI, more than 20% engaged in SA, and over 40% reported NSSI. The polarity of mood episodes was independently associated with SI ([hypo]mania vs. mixed episodes: odds ratio [OR] = 0.22, 95% confidence interval [CI] 0.14-0.33, p < 0.001) and NSSI ([hypo]mania vs. mixed episodes: OR = 0.33, 95% CI 0.19-0.58, p < 0.001; depressive episodes vs. mixed episodes: OR = 0.59, 95% CI 0.35-0.98, p = 0.040). Participants with mixed episodes reported the most severe addictive features of NSSI. SI was the most influential symptom within the network model of the total sample; NSSI, SI, and depressive symptoms were identified as key "bridge symptoms".

CONCLUSIONS

Suicidality and NSSI in BD were closely associated with depressive and mixed episodes, with mixed episodes showing the highest prevalence of NSSI and the most pronounced addictive features. SI was identified as the central symptom within the self-harm network, emphasizing its importance as an intervention target. These findings could offer potential insights regarding suicidality and NSSI in BD that can inform intervention strategies.

Analysis of maintenance pharmacotherapy in Chinese bipolar disorder patients: Guideline concordance and adjunctive medication use

OBJECTIVE

We collected maintenance treatment medication information from Chinese multicenter bipolar disorder patients, exploring the characteristics of medication use and related factors. We analyzed medication guideline adherence and compared trends in medication use with a study from 2014.

METHODS

323 patients receiving maintenance therapy for bipolar disorder across 20 hospitals have been recruited. Their prescription information was collected to compare with the recommended drug protocols outlined by CANMAT to assess consistency. Additionally, descriptive statistics were conducted to document the quantities and percentages of different classes of medications used. Regression analysis was employed to explore factors influencing medication choices.

RESULT

The rate of medication inconsistency in this study was 12.38 %, characterized by inappropriate use of antidepressants and mood stabilizers. The rate of using additional drugs was 67.80 %, with antipsychotics being the most common adjunctive treatment in the Bipolar I group and antidepressants in the Bipolar II group. Factors influencing the occurrence of adjunctive therapy included previous hospitalization, most recent episode type, and gender. The rate of polypharmacy was 47.10 %, with previous hospitalization and most recent episode type being the main influencing factors.

CONCLUSION

There has been a noticeable improvement in guideline concordance in medication use compared to 2014; however, improper use of antidepressants remains a significant clinical issue. The increasing prevalence of adjunctive medication use underscores the need for more personalized medication recommendations in clinical guidelines.

Altered cerebellar subregion functional connectivity and structure in patients with pediatric bipolar depression

To explore the structural and functional changes of Cerebellar Subregion in patients with pediatric bipolar disorder (PBD) patients and its clinical significance by using multimodal magnetic resonance imaging, so as to further explore the specific role of the cerebellum in PBD. This study included 48 pediatric patients with bipolar disorder (PBD) in the depressive phase from the outpatient clinic of the Department of Psychosomatic Medicine of the First Affiliated Hospital of Nanchang University. 22 healthy controls (HCs) matched for gender, age, handedness and education level were chosen from the community as the control group. All subjects underwent 3.0T resting-state functional magnetic resonance imaging (rs-fMRI) scans and completed clinical scales, including the Hamilton Depression Scale (HAMD) and Young Mania Rating Scale (YMRS). The cerebellum was categorized into 34 distinct subregions (R17, L17) based on SUIT and designated as seed points to perform whole-brain functional connectivity (FC). Group differences in categorical variables were assessed using the chi-square test, while continuous variables were compared employing the two-sample t-test. Correlations between FC and clinical parameters were analyzed for differential brain intervals. Compared with HCs, PBD patients in the depressive phase showed reduced FC between the left cerebellar lobules I-IV and the occipital inferior lobe (Occipital_Inf_L), cerebellar vermis VIIIa, and VIIIb; decreased FC between cerebellar cerebellar vermis VI and the frontal inferior orbital gyrus (Frontal_Inf_Orb_L), as well as the right cerebellar Crus 1; reduced FC between the left cerebellar Crus I and the dentate nucleus; decreased FC between cerebellar vermis VIIIa and the left superior frontal gyrus; reduced FC between the right cerebellar lobule IX and the right lingual gyrus; lowered FC between the left dentate and the dorsolateral prefrontal cortex, and the left lingual gyrus; FC between the left fastigial nucleus and the right cerebellar X decreased. Depressive phase of PBD patients exhibit altered functional connectivity within various subregions of the cerebellum, suggesting that the cerebellum is involved in central neural reorganization in PBD, which may be instructive for the understanding of central mechanisms and its future diagnostic and therapeutic target development.

Relationship of Perceived Burdensomeness and Thwarted Belongingness to Suicide Ideation Persistence and Suicide Behavior Over 12 Months in People With Serious Mental Illness

BACKGROUND AND HYPOTHESIS

People with serious mental illness (SMI) have an increased risk of suicide ideation (SI) and suicide behavior (SB). Longitudinal studies on factors contributing to SI/SB in SMI are lacking. Interpersonal biases (ie, perceived burdensomeness and thwarted belongingness) are cross-sectionally related to SI/SB, but do they relate to longitudinal suicide risk or other illness factors? Ecological momentary assessment (EMA) offers a powerful approach to a deeper understanding of these complex relationships.

STUDY DESIGN

Participants with SMI (N = 180) completed 3 in-lab visits (baseline, 6-month, and 12-month) and 10 days of EMA (3×/day) following the baseline visit. At all timepoints, participants were assessed for SI/SB and were classified as persistent, intermittent, or no SI or any reports of SB over the 12-month follow-up. Multinomial logistic regression models examined whether EMA burdensomeness, belongingness, social motivations, and psychotic symptoms predicted SI persistence or SB over 12 months. Time-series network analysis compared participants' EMA data by baseline SI.

STUDY RESULTS

Burdensomeness and belongingness related to persistent SI 12 months, as did voices, suspiciousness, and social motivations. Only burdensomeness and belongingness related to increased risk of SB over 12 months. Network analyses revealed unique lagged relationships in the baseline SI group: of suspiciousness to belongingness and social avoidance motivation to burdensomeness when compared to the baseline group without SI.

CONCLUSIONS

These findings indicate the importance of interpersonal risk factors and suspiciousness to trajectories of SI and SB over 12 months in SMI. Pending replication, these constructs may be potential suicide prevention treatment targets in SMI.

Unipolar mania over the course of a 15-year follow-up study

OBJECTIVE

A proportion of patients with bipolar disorder (BD) manifests with only Unipolar mania (UM). We conducted a follow-up study of patients diagnosed with Unipolar mania and compared them as a group if they had a mild depressive episode with those who did not.

METHOD

248 subjects were prospectively followed-up to 15 years. During the 15-year follow-up study, Pure mania was defined as patients who did not experience mild depressive episodes(203) and Mania with mild depression was defined as patients who did experience mild depressive episodes(45). Then, we compare characterization of clinical features between Pure mania (PM) and Mania with mild depression (MMD).

RESULTS

Compared with the Mania with mild depression group, the Pure mania group had more psychotic symptoms, fewer suicidal behaviors, a higher proportion of morningness chronotype, better sleep quality, higher extraversion, lower neuroticism, and less harm avoidance personality traits. Substantially different lifetime comorbidity patterns were observed between the two groups.

CONCLUSION

Patients with Pure mania exhibited distinct clinical and psychosocial features compared with patients with the Mania with mild depression. Further studies are warranted to investigate the underlying mechanisms for diverse presentations in subgroups of BDs.

LIMITATIONS

These results apply to a relatively short outcome period, and the sample size is relatively small.

Outpatient Management of Bipolar Disorder in Older Adults

PURPOSEOF REVIEW

Old age bipolar disorder (OABD), increasingly common as the population ages, presents unique diagnostic and treatment challenges. This selective review focuses on issues especially relevant to outpatient management.

RECENT FINDINGS

People with OABD may have similar frequency and severity of mood episodes compared to younger adults. Depression predominates, and mixed symptoms in both depressive and manic episodes are common. Comorbidity and excess mortality are high, with a particular bidirectional association with cerebrovascular disease. Lithium may outperform valproic acid and second-generation antipsychotics in efficacy. Tolerability and long-term safety can be improved with relatively lower target drug therapeutic levels. Outpatient clinicians treating OABD should take an active role in the recognition and management of medical comorbidities. A careful history and examination might reveal subtle signs of bipolar disorder or mixed features and change treatment. A primary target for treatment is to reduce polypharmacy when appropriate. Further trials are needed to make specific and clear recommendations in OABD.

NEK4: prediction of available drug targets and common genetic linkages in bipolar disorder and major depressive disorder

Background

Bipolar disorder (BD) is a mental illness characterized by alternating episodes of elevated mood and depression, while major depressive disorder (MDD) is a debilitating condition that ranks second globally in terms of disease burden. Pharmacotherapy plays a crucial role in managing both BD and MDD. We investigated the genetic differences in populations of individuals with MDD and BD, and from a genetic perspective, we offered new insights into potential drug targets. This will provide clues to potential drug targets.

Methods

This study employed genome-wide association studies (GWAS) and summary-data-based Mendelian randomization (SMR) methods to investigate the genetic underpinnings of patients with bipolar disorder (BD) and major depressive disorder (MDD) and to predict potential drug target genes. Genetic variants associated with BD and MDD were identified through large-scale GWAS datasets. For BD, the study utilized a comprehensive meta-analysis comprising 57 BD cohorts from Europe, North America, and Australia, including 41,917 BD cases and 371,549 controls of European ancestry. This dataset included both type 1 and type 2 BD cases diagnosed based on DSM-IV, ICD-9, or ICD-10 criteria through standardized assessments. For MDD, we used data from a meta-analysis by Howard DM et al., which integrated the largest GWAS studies of MDD, totaling 246,363 cases and 561,190 controls. The SMR approach, combined with expression quantitative trait loci (eQTL) data, was then applied to assess causal associations between these genetic variants and gene expression, aiming to identify genetic markers and potential drug targets associated with BD and MDD. Furthermore, two-sample Mendelian randomization (TSMR) analyses were performed to explore causal links between protein quantitative trait loci (pQTL) and these disorders.

Results

The SMR analysis revealed 41 druggable genes associated with BD, of which five genes appeared in both brain tissue and blood eQTL datasets and were significantly associated with BD risk. Furthermore, 45 druggable genes were found to be associated with MDD by SMR analysis, of which three genes appeared simultaneously in both datasets and were significantly associated with MDD risk. NEK4, a common drug candidate gene for BD and MDD, was also significantly associated with a high risk of both diseases and may help differentiate between type 1 and type 2 BD. Specifically, NEK4 showed a strong association with BD (β brain=0.126, P FDR=0.001; βblood=1.158, P FDR=0.003) and MDD (β brain=0.0316, P FDR=0.022; βblood=0.254, P FDR=0.045). Additionally, NEK4 was notably linked to BD type 1 (βbrain=0.123, P FDR=2.97E-05; βblood=1.018, P FDR=0.002), but showed no significant association with BD type 2.Moreover, TSMR analysis identified four proteins (BMP1, F9, ITIH3, and SIGIRR) affecting the risk of BD, and PSMB4 affecting the risk of MDD.

Conclusion

Our study identified NEK4 as a key gene linked to both bipolar disorder (BD) and major depressive disorder (MDD), suggesting its potential as a drug target and a biomarker for differentiating BD subtypes. Using GWAS, SMR, and TSMR approaches, we revealed multiple druggable genes and protein associations with BD and MDD risk, providing new insights into the genetic basis of these disorders. These findings offer promising directions for precision medicine and novel therapeutic strategies in mental health treatment.

The association of pain screening and pain level with suicide among US veterans with comorbid musculoskeletal and bipolar disorder diagnoses

BACKGROUND

High suicide rates are documented among persons with bipolar disorder diagnoses and pain diagnoses, but few studies have examined the association of pain with suicide mortality in individuals with comorbid pain and bipolar disorders. This study assessed the association of pain screening and pain severity with suicide mortality among veterans with comorbid bipolar and musculoskeletal disorder (MSD) diagnoses.

METHODS

A retrospective cohort study was conducted on 168,021 patients within the Veterans Health Administration (VHA) who received an MSD diagnosis from 2000 to 2015 and had a bipolar disorder diagnosis. Pain severity, comorbidities, demographics, and suicide mortality were extracted from VHA databases. Poisson regression examined relative risk of suicide by the presence pain screening and pain severity ratings.

RESULTS

Pain was assessed in 72.73 % of veterans. Suicide risk was greater in those not assessed (0.98 % versus 0.77 % in assessed group). However, this result did not persist after adjusting for covariates (RR = 1.06). Among those assessed, higher suicide risk was associated with moderate (RR = 1.10), severe pain (RR = 1.06), and no pain (reference) relative to mild pain (RR = 0.99). Major depression, substance use disorders, and prescribed opioids and benzodiazepines increased risk.

LIMITATIONS

Data were obtained from medical records; diagnoses were not confirmed via formal assessment, and no information was available on actual medication use or purpose. Over 25 % of the sample were missing pain severity ratings, which could have affected results.

CONCLUSIONS

Suicide risk factors among persons with bipolar disorder are complex and multifactorial. Providers should prioritize suicide prevention efforts following new onset or worsening pain.

Mood disorders and suicide: pilot study on postmortem toxicologic evidence and adherence to psychiatric therapy by determining blood levels of medications

Suicide is one of the leading causes of death today, and among all mental illness, mood disorders account for one of the main risk factors. It is well known and proven that suicides are very common among people undergoing treatment and prescribed psychiatric medication. So far, however, there have only been a few studies dealing with this particular phenomenon. For this reason, autopsy patients who died by suicide, suffered from a mood disorder, and were known to be taking psychiatric medication at the time of death were selected for this study. The blood and urine samples taken during the autopsy underwent toxicological analysis and the results were compared with the prescribed therapy. A total of 22 people were included in the study: 12 presenting with depression and 10 with bipolar disorder. The toxicological analysis revealed that only 6 cases (27%) showed a qualitative match with the prescribed medication. In 5 cases (22.7%) the medication was only partially complied with and in 11 cases (50%) it was not complied with at all. Furthermore, even when medication was present, the value was often below the therapeutic range. Overall, more than 70% of the test subjects adhered to their medication only partially or not at all. Since treatment adherence is considered as a key factor in reducing the risk of suicide, this inevitably raises relevant clinical and forensic questions. Against this background, prospective monitoring of post-mortem medication levels in suicidal individuals and synergistic collaboration between clinicians and forensic pathologists could help to evaluate the effectiveness of specific medical interventions, highlight existing critical problems and develop new approaches to suicide prevention.

Psychoneural reduction revised: The case of suicidality in bipolar disorder

This paper uses suicidality in bipolar disorder (BD) to illustrate that multidimensional frameworks account for complex phenomena with cognitive, psychological, socioenvironmental and physiological components better than their reductionist counterparts. We challenge level-based reductionist models that regard a particular dimension as fundamental. To comprehensively understand complex psychiatric phenomena, multidimensional models that acknowledge the heterogeneity of aetiological factors, rather than homogenising them under a single dimension, must be utilised. Multidimensional models allow a better understanding of the individual context under which a psychiatric phenomenon arises, and the interrelationships between its different aetiological dimensions. Suicidality in BD is used as a case study because it particularly highlights the interplay between biological, psychological, sociocultural and experiential factors. The multidimensional nature of suicidality is reflected by the heterogeneous strategies by which it is managed. Although similar to suicidality in other contexts, in BD suicidality has distinctive structural characteristics that emphasise its multidimensionality. Consequently, investigating suicidality in BD yields claims generalisable to suicidality as a whole alongside novel insights on BD-specific features. For instance, suicidality in BD has physiological causal factors, e.g., genetic predisposition and aggravation by symptomatic periods. However, its other features underscore the causal roles of cognitions. In persons with BD, suicidality can persist beyond depression and is sometimes experienced during mania, possibly due to suicidal ideation persisting beyond symptomatic periods. This indicates the need to account for cognitive or psychological causal factors. Models of suicidality in BD typically adopt a non-level-based, non-reductionist approach, reflected in the diverse clinical strategies for managing suicidality in BD.

[Comparative study of cognitive impairment in subgroups of bipolar affective disorder types I and II, occurring with and without psychotic symptoms]

One of the developing research areas of bipolar affective disorder (BAD) is the study of the neurocognitive profile of the patients, supported by the clinical practice to address the issues of diagnosis, course prediction, response to drug therapy, as well as the relationship of cognitive impairment with the level of social and labor adaptation of patients, and mental health sciences to analyze the BAD subtypes and clarify their neurobiological ground. By searching using combinations of the keywords «bipolar disorder», «psychosis», «BD I type», «BD II type», «cognitive impairment», «cognitive dysfunction», «meta-analysis», and «review» in the PubMed and Google Scholar databases, relevant meta-analyses, reviews, and original research articles were identified. The results showed that the BAD subgroups with and without psychotic manifestations, types I and II BAD, have different structures of the neurocognitive profile and the depth and severity of cognitive impairment, which can be assumed to reflect differences in the neurobiological mechanisms of these disorders. For future studies, it is interesting to compare the neurocognitive profile and psychopathological manifestations of the subgroups discussed to study BAD further. Evaluating the neurocognitive profile of BAD subgroups may increase the effectiveness of the diagnosis and therapy. Determining reliable causal factors will help implement personalized therapeutic interventions and develop effective preventive programs.

[Long-term courses of bipolar disorders]

BACKGROUND

Bipolar disorder (short: BD) is a severe illness with very heterogeneous trajectories. While some of the patients show no or hardly any long-term impairments, other affected individuals show substantial neurocognitive deficits with a clear decline in psychosocial functioning. Which factors influence the course of the disease is the subject of current research efforts.

OBJECTIVE

This review presents the long-term course of bipolar disease and the factors influencing it. In particular, differential trajectory types are discussed. The cognitive and psychosocial functional level as well as the psychopathological characteristics of the disease are elucidated. In addition, biological factors and treatment approaches influencing the course and prognosis are identified.

MATERIAL AND METHODS

Literature search using PubMed focusing on longitudinal studies over several years (see online supplement).

RESULTS

To date, there are only a few predictors and biomarkers that allow prediction of long-term progression. None have been sufficiently studied to enable clinical use. Appropriate pharmacological and psychotherapeutic treatment of those affected is essential to avoid renewed episodes of the disease.

DISCUSSION

The long-term course of bipolar disorder is highly heterogeneous and multifaceted. Despite intensive research efforts, no predictors have yet been identified that reliably predict the clinical course. This makes further research all the more important in order to offer individualized therapy options, develop new therapies and positively influence the course of the disease at an early stage.

Suicidal thoughts and behaviors in adults with hoarding disorder

BACKGROUND

Hoarding disorder (HD) is characterized by difficulty discarding possessions and clutter that impairs daily functioning. Previous research has demonstrated a high correlation between hoarding behaviors and suicidal thoughts and behaviors; however, there is limited research on suicidal thoughts and behaviors in individuals meeting Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for HD. Our aim in this study was to report our findings about suicidal thoughts and behaviors in a HD sample.

METHODS

We used existing data from participants meeting DSM-5 criteria for HD (n = 99). Data about suicidal thoughts and behaviors was collected using a structured instrument, the Columbia-Suicide Severity Rating Scale (C-SSRS).

RESULTS

Among the 99 participants, 49.5 % and 26.3 % had passive and active suicidal ideation (SI), respectively. Of those with active ideation, 11 participants endorsed thinking about overdose during their most severe SI. 13 participants reported attempting suicide at least once in their lifetime.

CONCLUSIONS

To our knowledge, this is the first study examining suicidal thoughts and behaviors in HD using the structured assessment C-SSRS. In this HD data set, participants reported suicidal thoughts and behaviors at higher rates than the general U.S.

POPULATION

Our study highlights the importance of screening for suicidal thoughts and behaviors in individuals with HD.

SKA2 enhances stress-related glucocorticoid receptor signaling through FKBP4-FKBP5 interactions in neurons

Genes involved in regulating the hypothalamic-pituitary-adrenal (HPA) axis, including the glucocorticoid receptor (GR), are linked to various stress-related psychopathologies including bipolar disorder as well as other mood and trauma-related disorders. The protein product of the cell cycle gene, SKA2, is a GR interaction partner in peripheral cells. However, the precise roles of SKA2 in stress and GR signaling in the brain, specifically in nonreplicating postmitotic neurons, and its involvement in HPA axis regulation remain unclear. Here, we demonstrate, using diverse in vitro cell assays, a mechanism by which SKA2 promotes GR signaling through enhancing GR-FKBP4 interaction leading to dissociation of FK506-bindingprotein 51 (FKBP5) from the complex. FKBP4 and FKBP5 are cochaperones known to regulate GR function in opposite directions. Notably in mice, SKA2 in Crh+ neurons of the paraventricular nucleus of the hypothalamus is crucial for HPA axis responsiveness and for maintaining the negative feedback loop underlying allostasis. Moreover, we show that SKA2 expression is increased in postmortem human hippocampus and amygdala from individuals with BD. Our study highlights a critical role of SKA2 in HPA axis function, adds to the understanding of the molecular basis of stress-related psychiatric disorders, and points to potential targets for intervention.

Evaluation of the Early Development of 6-Month-Old Babies in the Case of Maternal Postpartum Depression with or Without Bipolar Disorder

BACKGROUND

The first year of life is the period of greatest brain plasticity. Postpartum depression can adversely affect the first interactions with the child and, consequently, their emotional, social, and cognitive development.

OBJECTIVES

First, to describe the developmental profile of six-month-old infants of mothers suffering from severe postpartum depression, and, second, to compare the development of infants whose mothers suffer from depression with or without bipolar disorder.

METHODS

This is a retrospective descriptive study on 6-month-old babies hospitalized with their mothers at the Marseille Mother-Baby Unit (MBU) for maternal postpartum depression with or without bipolar disorder. Mothers were clinically diagnosed by a psychiatrist specialized in postpartum depression using the DSM-5; infant development was assessed at 6 months by an independent health professional using the revised Brunet-Lézine Scale, which allowed the calculation of global and partial developmental quotients (DQ).

RESULTS

We followed 40 mother-infant dyads. None of the 40 infants had a global developmental delay. However, maternal depression was significantly associated with poorer sociability (mean sociability DQ score of 94 ± 9.6, p < 0.001) and lower postural development (mean postural DQ score of 96.2 ± 8.9 *, p < 0.001) in the infants at 6 months of age. Postural development was significantly lower in children of bipolar mothers than in children of non-bipolar mothers (p = 0.03).

CONCLUSIONS

Postpartum depression was associated with a weakness in sociability and posture at the age of 6 months, without relevant developmental delay. Screening infants at an early age with specific tools allows for earlier intervention, which would positively influence their developmental trajectory.

Association between a large change between the minimum and maximum monthly values of solar insolation and a history of suicide attempts in bipolar I disorder

BACKGROUND

The rate of suicide attempts by patients with bipolar disorder is high. In addition to patient and country specific factors, environmental factors may contribute to suicidal behavior. Sunlight has multiple diverse impacts on human physiology and behavior. Solar insolation is defined as the electromagnetic energy from the sun striking a surface area on earth. We previously found that a large change in solar insolation between the minimum and maximum monthly values was associated with an increased risk of suicide attempts in patients with bipolar I disorder.

METHODS

The association between solar insolation and a history of suicide attempts in bipolar disorder was again investigated using an international database with 15% more data and more sites at diverse locations and countries.

RESULTS

Data were available from 5641 patients with bipolar I disorder living at a wide range of latitudes in 41 countries in both hemispheres. A large change in solar insolation between the minimum and maximum monthly values was associated with a history of suicide attempts in patients with bipolar I disorder, a replication of our prior analysis. The estimated model also associated state sponsored religion in the onset country, female gender, a history of alcohol or substance abuse, and being part of a younger birth cohort with a history of suicide attempts.

CONCLUSIONS

A large change between the minimum and maximum monthly values of solar insolation was associated with a history of suicide attempts in bipolar I disorder, replicating our prior research. Physicians should be aware that daylight has wide ranging physiological and psychiatric impacts, and that living with large changes in solar insolation may be associated with an increased suicide risk.

Individual suicide risk factors with resting-state brain functional connectivity patterns in bipolar disorder patients based on latent Dirichlet allocation model

BACKGROUND

The widespread problem of suicide and its severe burden in bipolar disorder (BD) necessitate the development of objective risk markers, aiming to enhance individual suicide risk prediction in BD.

METHODS

This study recruited 123 BD patients (61 patients with prior suicide attempted history (PSAs), 62 without (NSAs)) and 68 healthy controls (HEs). The Latent Dirichlet Allocation (LDA) model was used to decompose the resting state functional connectivity (RSFC) into multiple hyper/hypo-RSFC patterns. Thereafter, according to the quantitative results of individual heterogeneity over latent factor dimensions, the correlations were analyzed to test prediction ability.

RESULTS

Model constructed without introducing suicide-related labels yielded three latent factors with dissociable hyper/hypo-RSFC patterns. In the subsequent analysis, significant differences in the factor distributions of PSAs and NSAs showed biases on the default-mode network (DMN) hyper-RSFC factor (factor 3) and the salience network (SN) and central executive network (CEN) hyper-RSFC factor (factor 1), indicating predictive value. Correlation analysis of the individuals' expressions with their Nurses' Global Assessment of Suicide Risk (NGASR) revealed factor 3 positively correlated (r = 0.4180, p < 0.0001) and factor 1 negatively correlated (r = - 0.2492, p = 0.0055) with suicide risk. Therefore, it could be speculated that patterns more associated with suicide reflected hyper-connectivity in DMN and hypo-connectivity in SN, CEN.

CONCLUSIONS

This study provided individual suicide-associated risk factors that could reflect the abnormal RSFC patterns, and explored the suicide related brain mechanisms, which is expected to provide supports for clinical decision-making and timely screening and intervention for individuals at high risks of suicide.

Suicidal behavior in patients with severe mental disorders prior to and during the COVID-19 pandemic

BACKGROUND

Determining whether the incidence of suicidal behavior during the COVID-19 pandemic changed for those with severe mental disorders is essential to ensure the provision of suicide preventive initiatives in the case of future health crises.

METHODS

Using population-based registers, quarterly cohorts from the first quarter of 2018 (2018Q1) to 2021Q4 were formed including all Swedish-residents >10 years old. Interrupted time series and generalized estimating equations analyses were used to evaluate changes in Incidence Rates (IR) of specialised healthcare use for suicide attempt and death by suicide per 10 000 person-years for individuals with or without specific severe mental disorders (SMDs) during, compared to before the pandemic.

RESULTS

The IR (95% Confidence interval, CI) of suicide in individuals with SMDs decreased from 16.0 (15.0-17.1) in 2018Q1 to 11.6 (10.8-12.5) in 2020Q1 (i.e. the quarter before the start of the pandemic), after which it dropped further to 6.7 (6.3-7.2) in 2021Q2. In contrast, IRs of suicide attempt in SMDs showed more stable trends, as did the trends regarding suicide and suicide attempt for individuals without SMD. These discrepancies were most evident for individuals with substance use disorder and ASD/ADHD. Changes in IRs of suicide v. suicide attempt for one quarter during the pandemic for substance misuse were 11.2% v. 3.6% respectively. These changes for ASD/ADHD were 10.7% v. 3.6%.

CONCLUSIONS

The study shows pronounced decreases in suicide rates in individuals with SMDs during the pandemic. Further studies aiming to understand mechanisms behind these trends are warranted to consult future suicide prevention strategies.

Prevalence and correlates of non-suicidal self-injury among patients with bipolar disorder: A multicenter study across China

BACKGROUND

Non-suicidal self-injury (NSSI) is increasingly prevalent among patients with bipolar disorder (BD), raising concerns in psychology and mental health. Investigating the incidence and factors associated with NSSI is crucial for developing prevention and intervention strategies.

METHODS

NSSI behaviors were identified using the Ottawa Self-injury Inventory. The Clinically Useful Depression Outcome Scale supplemented with questions for the DSM-5 specifier of mixed features (CUDOS-M) and the Mini International Neuropsychiatric Interview (Hypo-)Manic Episode with Mixed Features-DSM-5 Module (MINI-M) were used to evaluate clinical symptoms. Non-parametric tests, chi-square tests, point-biserial correlation and logistic regression analyses were employed for the purposes of data analysis.

RESULTS

The enrolled sample comprised 1044 patients with BD from 20 research centers across China. Out of 1044 individuals, 446 exhibited NSSI behaviors, with 101 of them being adolescents, leading to a prevalence of 78.3 % among adolescent patients. The most common methods for females and males were "cutting" (41.2 %) and "hitting" (34.7 %), respectively. By binary logistic regression analysis, young age, female, bipolar type II disorder, with suicidal ideation and mixed states, depressive symptoms and without family history of mental disorder were correlates of NSSI in patients with BD (P < 0.05).

LIMITATIONS

As a cross-sectional study, causality between NSSI behaviors and associated factors cannot be established. Reporting and recall biases may occur due to self-rating scales and retrospective reports.

CONCLUSION

Our study indicates a concerning prevalence of NSSI, particularly among young patients with BD in China. Future research should focus on understanding NSSI behaviors in this population and developing effective interventions.

Enhancing Transcriptomic Insights into Neurological Disorders Through the Comparative Analysis of Shapley Values

Neurological disorders such as Autism Spectrum Disorder (ASD), Schizophrenia (SCH), Bipolar Disorder (BD), and Major Depressive Disorder (MDD) affect millions of people worldwide, yet their molecular mechanisms remain poorly understood. This study describes the application of the Comparative Analysis of Shapley values (CASh) to transcriptomic data from nine datasets associated with these complex disorders, demonstrating its effectiveness in identifying differentially expressed genes (DEGs). CASh, which combines Game Theory with Bootstrap resampling, offers a robust alternative to traditional statistical methods by assessing the contribution of each gene in the broader context of the complete dataset. Unlike conventional approaches, CASh is highly effective at detecting subtle but meaningful molecular patterns that are often missed. These findings highlight the potential of CASh to enhance the precision of transcriptomic analysis, providing a deeper understanding of the molecular mechanisms underlying these disorders and establishing a solid basis to improve diagnostic techniques and developing more targeted therapeutic interventions.

Personality functioning in bipolar 1 disorder and borderline personality disorder

BACKGROUND

Differentiation of borderline personality disorder (BPD) and bipolar I disorder (BD) has been challenging. The assessment of shared symptoms in the context of the overall personality functioning, the patient's sense of self, and the quality of his object (interpersonal) relations is proposed to be valuable for the differential diagnosis of these disorders.

METHODS

We empirically investigated the level of personality organization (PO), identity integration, and quality of object relations in patients suffering from BD or BPD using the Structured Interview of Personality Organization (STIPO) and the Level of Personality Functioning Scale (LPFS) in 34 BPD and 28 BD patients as well as 27 healthy control persons. Group comparisons and a logistic regression model were calculated to analyze group differences.

RESULTS

The BPD group showed significantly greater impairment in several domains of personality functioning, namely "identity", and "self- and other-directed aggression", while showing lower impairment in "moral values". The overall level of PO in the BPD group was significantly lower when excluding not only BPD but any personality disorder (PD) in the BD sample. Severity of impaired personality structure had a major impact on symptom load independent of the main diagnosis BD or BPD.

CONCLUSIONS

Our data show greater impairment in personality functioning in BPD than in BD patients. BD patients present with varying levels of PO, whereas in BPD severe deficits in PO are pathognomonic. The level of PO has a significant impact on symptom severity in both BD and BPD patients. Therefore, careful assessment of PO should be considered for differential diagnosis and adequate treatment planning.

Real-world clinical determinants of alcohol dependence in outpatients with bipolar disorder: a multicenter treatment survey for bipolar disorder in psychiatric outpatient clinics with 2,392 participants

Background

Bipolar disorder is a psychiatric disorder characterized by mood swings between manic and depressed states that causes psychosocial problems. Cognitive function deteriorates with each recurrence, making it important to maintain remission through continued treatment. Bipolar disorder often co-occurs with alcohol dependence, which is known to lead to decreased treatment adherence and increased suicide risk. However, the real-world clinical determinants of alcohol dependence in outpatients with bipolar disorder in Japan remain unclear.

Methods

We conducted an observational study targeting 2392 patients with bipolar disorder using data from the MUSUBI study, a joint project of the Japanese Association of Neuro-Psychiatric Clinics and the Japanese Society of Clinical Neuropsychopharmacology. After determining the prevalence of alcohol dependence and the sociodemographic characteristics of patients with bipolar disorder, multivariate analysis was performed to identify risk factors for alcohol comorbidity.

Results

The prevalence of alcohol dependence among outpatients with bipolar disorder in this study was 5.7%. The prevalence was 7.6% for males and 3.1% for females. The results of the binomial logistic regression analysis revealed that bipolar I disorder, manic state, comorbidities with other psychiatric disorders, male sex, and suicidal ideation were significantly associated with alcohol dependence. Stratified analysis by gender showed that alcohol dependence was more strongly associated with the presence of suicidal ideation in women than in men.

Limitation

First, because this was an observational study with a cross-sectional design, causal relationships between factors cannot be determined. In addition, this study included outpatients in Japan but lacked information on inpatients. Therefore, it was considered necessary to conduct the study on a larger population in order to generate more robust evidence.

Conclusions

We found that outpatients with bipolar disorder, especially men, had higher rates of alcohol dependence overall than the general population in Japan. In addition, the relationship between alcohol dependence and suicidal ideation was stronger in women than in men with bipolar disorder. There was a strong association between manic states and alcohol dependence in outpatients with bipolar disorder. These results are useful to clinicians because they reinforce real-world clinical evidence for the treatment of bipolar disorder and co-occurring alcohol dependence.

Prescribing patterns for older-age bipolar disorder patients discharged from two public mental hospitals in Taiwan, 2006-2019

BACKGROUND

Older-age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. There have been no studies to examine temporal trends in the pharmacological treatment of OABD. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019.

METHODS

OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilisers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics (SGAs and FGAs)), and antidepressants, were investigated. Complex polypharmacy was defined as the use of three or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test.

RESULTS

The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilisers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilisers, lithium, FGAs, and antidepressants plus mood stabilisers significantly decreased.

CONCLUSIONS

Prescribing patterns changed remarkably for OABD patients over a 14-year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.

Onset of bipolar disorder by COVID-19: The roles of endogenous ouabain and the Na,K-ATPase

Bipolar Disorder (BD) is a psychiatric disorder marked by mood swings between manic and depressive episodes. The reduction in the Na,K-ATPase (NKA) enzyme activity and the inability of individuals with BD to produce endogenous ouabain (EO) at sufficient levels to stimulate this enzyme during stressful events are factors proposed for BD etiology. According to these hypotheses, reduction in NKA activity would result in altered neuronal resting potential, leading to BD symptoms. Recently, damage to the adrenals (EO synthesis site) in coronavirus disease (COVID-19) patients has been reported, however studies pointing to the pathophysiological mechanisms shared by these two diseases are scarce. Through a literature review, this study aims to correlate COVID-19 and BD, focusing on the role of NKA and EO to identify possible mechanisms for the worsening of BD due to COVID-19. The search in the PubMed database for the descriptors ("bipolar disorder" AND "Na,K-ATPase"), ("bipolar disorder" AND "endogenous ouabain"), ("covid-19" AND "bipolar disorder") and ("covid-19" AND "adrenal gland") resulted in 390 articles. The studies identified the adrenals as a vulnerable organ to SARS-CoV-2 infection. Cases of adrenal damage in patients with COVID-19 showing lower levels of adrenal hormones were reported. Cases of COVID-19 patients with symptoms of mania were reported worldwide. Given these results, we propose that adrenal cortical cell damage could lead to EO deficiency following neuronal NKA activity impairment, with small reductions in activity leading to mania and greater reductions leading to depression.

Practice Guidelines for Bipolar Disorder by the JSMD (Japanese Society of Mood Disorders)

The Japanese Society of Mood Disorders (JSMD) published treatment guidelines of bipolar disorder in 2011. The present guidelines incorporating new findings were developed to comply to the guidelines of the National Academy of Medicine (NAM) by utilizing systematic reviews and meta-analysis and taking patient and family opinions as well as insights from multiple professional fields into account. They support combination therapy using mood stabilizers and second-generation antipsychotics in many aspects. They also have limitations, including the grouping of mood stabilizers and second-generation antipsychotics when meta-analysis was performed despite their distinct properties, due to the scarcity of drug-specific evidence. Despite the limitations, these guidelines provide clinical decision support for psychiatrists in Japan.

Suicide Rates and Subgroups With Elevated Suicide Risk Among Patients With Psychiatric Disorders: A Nationwide Cohort Study in Korea

BACKGROUND

Despite the distinctly high risk of suicide among patients with psychiatric disorders, little is known regarding the nationwide rates and risk factors for suicide among individual subgroups of patients with psychiatric disorders. This study aimed to assess differences in suicide rates and identify risk factors for suicide across multiple psychiatric diseases using data from a nationally representative cohort in Korea.

METHODS

Six groups of incident patients with psychiatric disorders, namely those with drug use disorder (DUD), alcohol use disorder (AUD), schizophrenia (SCZ), bipolar disorder (BD), depressive disorder (DD), or other affective disorders (OADs), were extracted from the National Health Information Database and followed up. Suicide rates and risk factors were then determined for each disease group.

RESULTS

Patients with psychiatric disorders had higher suicide rates than did the general population, with standardized mortality ratios (SMRs) ranging from 2.5 to 16.6. In particular, patients with DUD showed markedly higher suicide rate (584.0 per 100,000 person-years [PYs]; SMR, 16.6) than did patients with affective disorders, including DD (119.8 per 100,000 PYs; SMR, 3.1). AUD, DUD, SCZ, and BD showed lower male/female suicide rate ratios (1.1-1.4) than did depressive and OADs (2.2-2.4). Old age increased the risk for suicide among those with DUD and OADs, while medical aid recipients exhibited the lowest suicide risk among those with the AUD and SCZ. Male sex and the presence of multiple psychiatric comorbidities were consistently identified as suicide risk factors across mental illness subgroups.

CONCLUSION

The current study observed substantial variations in suicide rates and risk factors across psychiatric disorders and patient characteristics, which have significant implications for suicide prevention strategies.

The major biogenic amine metabolites in mood disorders

Mood disorders, including major depressive disorder and bipolar disorder, have a profound impact on more than 300 million people worldwide. It has been demonstrated mood disorders were closely associated with deviations in biogenic amine metabolites, which are involved in numerous critical physiological processes. The peripheral and central alteration of biogenic amine metabolites in patients may be one of the potential pathogeneses of mood disorders. This review provides a concise overview of the latest research on biogenic amine metabolites in mood disorders, such as histamine, kynurenine, and creatine. Further studies need larger sample sizes and multi-center collaboration. Investigating the changes of biogenic amine metabolites in mood disorders can provide biological foundation for diagnosis, offer guidance for more potent treatments, and aid in elucidating the biological mechanisms underlying mood disorders.

Association of Ventricular Arrhythmias with Lamotrigine: An Observational Cohort Study

Background

Whether lamotrigine (LTG) is associated with ventricular tachycardia (VT) in bipolar disorder (BPD), partial seizures (PSZ) and generalized tonic-clonic seizures (GTSZ) with and without structural heart disease (SHD) remains controversial. A mechanistic rational for LTG-induced re-entrant cardiac arrhythmias has recently been elucidated, leading to a real-world comparative cohort observational study being warranted.

Methods

A retrospective observational comparative safety study was performed using a large healthcare claims database of adult participants analyzing the one-year cumulative VT. Analytic cohort included adult participants diagnosed with bipolar I disorder (BPD), partial seizures (PSZ) or generalized tonic-clonic seizures (GTSZ). Participants were free from supraventricular or ventricular arrhythmias during the 6-month baseline period before the index LTG or CTR date. Exposure to LTG versus commonly prescribed alternative agents were the control comparators (CTR). One-year cumulative ventricular tachycardia (VT) incidence was calculated separately for GTSZ, PSZ and BPD using Kaplan-Meier estimator, with participants being censored at last enrollment, treatment switching or discontinuation. The VT association hazard ratios (HR) for LTG versus CTR was adjusted for baseline characteristics.

Results

The analytic cohort included 153,852 LTG and 213,593 CTR for BPD, 10,275 LTG and 24,971 CTR for PSZ, and 5,860 LTG and 17,506 CTR for GTSZ. Baseline cardiovascular risk profiles were higher among CTR than LTG across the three sub-analytic cohorts. The 1-year VT cumulative incidence from LTG or CTR free from was 0.79% vs 0.68% in BPD, 0.76% vs 0.58% in PSZ, and 0.93% vs 0.40% in GTSZ cohorts, The adjusted HR [95% CI] estimates were 1.326 [1.122-1.568, p<0.01], 1.403 [0.920-2.138, p=0.11], and 1.180 [0.607-2.295, p=0.63].

Conclusions

In adult participants, LTG has a strong association to increase VT risk compared to commonly prescribed alternatives.

KEY POINTS

Question: Does lamotrigine investigated in a real-world database increase the risk of ventricular tachycardia in patients with epilepsy or bipolar disease? Findings: The lamotrigine-ventricular tachycardia association was statistically significant in adult bipolar disease participants. Although limited statistical significance, the positive association is ubiquitous across epileptic conditions. Structural heart disease has a notable increased effect on the incidence on the onset of ventricular tachycardia. Meaning: Caution should be exercised in the use of lamotrigine in adult bipolar disease patients to avoid ventricular tachycardia.

Assessing suicide risk in chronic pain management: a narrative review across drug classes

INTRODUCTION

Chronic pain presents a multifaceted challenge in clinical practice, necessitating a nuanced understanding of pharmacological interventions to optimize treatment outcomes. This review provides an outline of various pharmacological agents commonly used in chronic pain management and highlights their safety considerations, particularly regarding suicide risk.

AREAS COVERED

This review discusses the role of antidepressants, anticonvulsants, GABA receptor agonists, NMDA receptor antagonists, corticosteroids, cannabis and cannabinoids, bisphosphonates, calcitonin, and alpha-2 adrenergic receptor agonists in chronic pain management. It assesses their therapeutic benefits, potential for misuse, and psychiatric adverse effects, including the risk of suicide. Each pharmacological class is evaluated in terms of its efficacy, safety profile, and considerations for clinical practice. We searched peer-reviewed English literature on the topic using the MEDLINE database without time restrictions.

EXPERT OPINION

While pharmacological interventions offer promise in alleviating chronic pain, healthcare providers must carefully weigh their benefits against potential risks, including the risk of exacerbating psychiatric symptoms and increasing suicide risk. Individualized treatment approaches, close monitoring, and multidisciplinary collaboration are essential for optimizing pain management strategies while mitigating adverse effects. Ongoing research efforts are crucial for advancing our understanding of these pharmacological interventions and refining pain management practices.

Transitional photoperiod induces a mania-like behavior in male mice

This study aimed to investigate the behavioral responses and circadian rhythms of mice to both rapid and gradual increases in photoperiod, mimicking the transition from winter to summer, which is associated with a heightened prevalence of hospitalizations for mania and suicidal behavior. Behavioral tests were performed in C57BL/6 male mice exposed to a transitional photoperiod, from short to long durations. To determine if circadian rhythms are affected, we measured spontaneous locomotor activity and body temperature. Mice exhibited heightened exploratory and risk-taking behaviors compared with equatorial and static long (16:8 h of light-dark cycle for several days) groups. These behaviors were prevented by lithium. Spontaneous locomotor activity and body temperature rhythms persisted and were effectively synchronized; however, the relative amplitude of activity and interdaily stability were diminished. Additionally, the animals displayed increased activity during the light phase. Photoperiodic transition modulates behavior and circadian rhythms, mirroring certain features observed in bipolar disorder patients. This study introduces an animal model for investigating mania-like behavior induced by photoperiodic changes, offering potential insights for suicide prevention strategies and the management of mood disorders.

Suicide-related mortality in cardiovascular disease in the United States from 1999 to 2019

INTRODUCTION

Research has shown chronic diseases can be associated with suicide but there is limited data on suicide in cardiovascular disease (CVD). Given the substantial psychosocial, financial, quality of life, and health impact of CVD, we aimed to study suicide-related mortality in CVD.

METHODS

We used Center for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access Multiple Cause of Death data from 1999 to 2019. Suicide and CVD related deaths in patients ≥ 25 years were identified. Proportionate suicide-related mortality (PSrM) was calculated as suicide-related deaths (listed with CVD) divided by all CVD-related deaths (irrespective of suicide) and reported as PSrM per 100,000 CVD-related deaths. Joinpoint regression was used to examine trend changes using annual percentage change (APC) overall and by sex, race/ethnicity, disease subtype, and age.

RESULTS

Overall, PSrM in CVD increased from 62.8 in 1999 to 90.5 in 2019. The PSrM increased from 1999 to 2002 with an associated APC of 6.2 (95 % CI, 0.0 to 12.7), remained stable from 2002 to 2005, increased from 2005 to 2013 with an APC of 4.8 (95 % CI, 3.4 to 6.3), and decreased from 2013 to 2019 with an APC of -2.1 (95 % CI, -3.6 to -0.5). Among racial/ethnic groups, PSrM was highest in non-hispanic (NH) White (103.8), then Hispanic or Latino (63.6), and then NH Black or African American individuals (29.2). PSrM was highest in the 25-39 years age group (858), then 40-54 years (382.8), 55-69 years (146.2), 70-84 years (55.9), and then 85+ (17). PSrM initially increased in men with APC (3.1 until 2013), women (4.1 until 2014), NH White individuals (3.9 until 2013), Hispanic or Latino (3.5 until 2014), ages 40-54 years (2.9 until 2013), 55-69 years (6.0 until 2013), then stabilized or decreased. AAMR increased in NH Black or AA individuals APC (1.0) and 25-39 years APC (1.4) from 1999 to 2019.

CONCLUSION

PSrM in CVD peaked in the early 2010s, with varying differences across sex, racial/ethnic, and age groups. Further research is needed to understand disparities and develop preventive strategies.

Suicide Probability Among Patients With Schizophrenia and Bipolar Disorder

PURPOSE

To evaluate the possibility of suicide and related factors among individuals with schizophrenia and bipolar disorder (BD).

METHOD

Data were collected for 270 individuals registered in a community mental health center using the Suicide Probability Scale (SPS). Subsequently, t test and multiple linear regression analyses were conducted on independent samples.

RESULTS

There was no statistically significant difference found between mean SPS scores of participants with schizophrenia and BD. However, hostility subscale mean scores of participants with schizophrenia were higher than those of participants with BD, and the difference was statistically significant. Sex, family history of mental illness, need for help with medication, suicidal ideation in the past 10 days, and number of suicide attempts were important predictors of suicide probability.

CONCLUSION

Individuals with schizophrenia and BD and in remission should be evaluated periodically for the possibility of suicide. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 37-45.].

Early warning signals observed in motor activity preceding mood state change in bipolar disorder

INTRODUCTION

Alterations in motor activity are well-established symptoms of bipolar disorder, and time series of motor activity can be considered complex dynamical systems. In such systems, early warning signals (EWS) occur in a critical transition period preceding a sudden shift (tipping point) in the system. EWS are statistical observations occurring due to a system's declining ability to maintain homeostasis when approaching a tipping point. The aim was to identify critical transition periods preceding bipolar mood state changes.

METHODS

Participants with a validated bipolar diagnosis were included to a one-year follow-up study, with repeated assessments of the participants' mood. Motor activity was recorded continuously by a wrist-worn actigraph. Participants assessed to have relapsed during follow-up were analyzed. Recognized EWS features were extracted from the motor activity data and analyzed by an unsupervised change point detection algorithm, capable of processing multi-dimensional data and developed to identify when the statistical property of a time series changes.

RESULTS

Of 49 participants, four depressive and four hypomanic/manic relapses among six individuals occurred, recording actigraphy for 23.8 ± 0.2 h/day, for 39.8 ± 4.6 days. The algorithm detected change points in the time series and identified critical transition periods spanning 13.5 ± 7.2 days. For depressions 11.4 ± 1.8, and hypomania/mania 15.6 ± 10.2 days.

CONCLUSION

The change point detection algorithm seems capable of recognizing impending mood episodes in continuous flowing data streams. Hence, we present an innovative method for forecasting approaching relapses to improve the clinical management of bipolar disorder.

Associations of altered leukocyte DDR1 promoter methylation and childhood trauma with bipolar disorder and suicidal behavior in euthymic patients

Altered DNA methylation (DNAm) patterns of discoidin domain receptor 1 (DDR1) have been found in the blood and brain of patients with schizophrenia (SCZ) and the brain of patients with bipolar disorder (BD). Childhood trauma (CT) is associated with changes in DNAm that in turn are related to suicidal behavior (SB) in patients with several psychiatric disorders. Here, using MassARRAY® technology, we studied 128 patients diagnosed with BD in remission and 141 healthy controls (HCs) to compare leukocyte DDR1 promoter DNAm patterns between patients and HCs and between patients with and without SB. Additionally, we investigated whether CT was associated with DDR1 DNAm and mediated SB. We found hypermethylation at DDR1 cg19215110 and cg23953820 sites and hypomethylation at cg14279856 and cg03270204 sites in patients with BD compared to HCs. Logistic regression models showed that hypermethylation of DDR1 cg23953820 but not cg19215110 and CT were risk factors for BD, while cg14279856 and cg03270204 hypomethylation were protective factors. In patients, CT was a risk factor for SB, but DDR1 DNAm, although associated with CT, did not mediate the association of CT with SB. This is the first study demonstrating altered leukocyte DDR1 promoter DNAm in euthymic patients with BD. We conclude that altered DDR1 DNAm may be related to immune and inflammatory mechanisms and could be a potential blood biomarker for the diagnosis and stratification of psychiatric patients.

Relationships Among Demographic Factors, Stigma, Social Support, and Self-Management in Individuals With Bipolar Disorder in Remission

The current cross-sectional study aimed to investigate the extent to which demographic characteristics, stigma, and social support impact the self-management abilities of individuals with bipolar disorder in remission. Participants (N = 114) completed a demographic questionnaire, Self-Stigma Scale-Short Form, Social Support Rating Scale, and Self-Management Scale for Patients With Bipolar Disorder. Mean scores were 60.65 (SD = 10.42) for self-management, 35.76 (SD = 7.14) for social support, and 21.38 (SD = 5.06) for stigma. In the univariate analysis, age, educational level, method of payment for care, illness duration, and number of hospitalizations demonstrated significant associations with self-management (p < 0.05). Correlation analysis revealed a positive correlation between self-management and social support (r = 0.574, p < 0.01) and negative correlations between self-management and stigma (r = -0.489, p < 0.01) and stigma and social support (r = -0.476, p < 0.01). Multiple linear regression analysis included number of hospitalizations (β = -3.818), social support (β = 0.436), literacy (β = 2.132), and stigma (β = -0.397). Individuals in remission from bipolar disorder exhibit moderate levels of self-management. Follow-up interventions should prioritize enhancing social support and addressing stigma to promote improved self-management and overall well-being. [Journal of Psychosocial Nursing and Mental Health Services, 62(7), 26-35.].

Molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania based on network pharmacology and molecular docking: Evidence from computational biology

BACKGROUND

Quetiapine monotherapy is recommended as the first-line option for acute mania and acute bipolar depression. However, the mechanism of action of quetiapine is unclear. Network pharmacology and molecular docking were employed to determine the molecular mechanisms of quetiapine bidirectional regulation of bipolar depression and mania.

METHODS

Putative target genes for quetiapine were collected from the GeneCard, SwissTargetPrediction, and DrugBank databases. Targets for bipolar depression and bipolar mania were identified from the DisGeNET and GeneCards databases. A protein-protein interaction (PPI) network was generated using the String database and imported into Cytoscape. DAVID and the Bioinformatics platform were employed to perform the Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of the top 15 core targets. The drug-pathway-target-disease network was constructed using Cytoscape. Finally, molecular docking was performed to evaluate the interactions between quetiapine and potential targets.

RESULTS

Targets for quetiapine actions against bipolar depression (126 targets) and bipolar mania (81 targets) were identified. Based on PPI and KEGG pathway analyses, quetiapine may affect bipolar depression by targeting the MAPK and PI3K/AKT insulin signaling pathways via BDNF, INS, EGFR, IGF1, and NGF, and it may affect bipolar mania by targeting the neuroactive ligand-receptor interaction signaling pathway via HTR1A, HTR1B, HTR2A, DRD2, and GRIN2B. Molecular docking revealed good binding affinity between quetiapine and potential targets.

LIMITATIONS

Pharmacological experiments should be conducted to verify and further explore these results.

CONCLUSIONS

Our findings suggest that quetiapine affects bipolar depression and bipolar mania through distinct biological core targets, and thus through different mechanisms. Furthermore, our results provide a theoretical basis for the clinical use of quetiapine and possible directions for new drug development.

Interpersonal relationships and suicidal ideation among Chinese youths: A network analysis

BACKGROUND

Suicidal ideation is a noteworthy health problem that requires further study in the field of interpersonal relationships. The main scope of relationships include family, teachers, peers, and the Internet. However, few studies have considered the effects of interpersonal interactions. Based on the Interpersonal Theory of Suicide, this study explores the relation between different interpersonal relationships and suicidal ideation.

METHODS

A network analysis approach was used to test the relationships. Cross-sectional data (N = 1694; 52.1 % boys; Mage = 11.86 years, SD = 1.59) were collected from primary and secondary students in October-November 2022. Participants completed a survey including demographic part and questionnaires: Positive and Negative Suicide Ideation Inventory (PANSI), Interpersonal Needs Questionnaire (INQ), Family Adaptability and Cohesion Evaluation Scale (FACES II), Inventory of Parent and Peer Attachment (IPPA), Student-Teacher Relationship Scale (STRS) and Facebook Intensity Scale (FIS).

RESULTS

All variables showed a significant correlation in this inferred network. Family, teacher-student, and peer relationships are protective against suicidal ideation. The closeness of the teacher-student relationship showed the highest strength centrality. However, online interpersonal relationship is a risk factor for suicide. Thwarted belongingness and perceived burdensomeness are proximal factors of suicidal ideation that influenced all interpersonal relationships.

LIMITATIONS

The network analysis as a data-driven and exploratory method may be limited to provide exact cause and effect relationship.

CONCLUSIONS

This study shows that teacher-student connections may be more important than other relationships of young people. Improper peer and online interpersonal relationship could be risky for suicide. Further studies are needed to examine the role of these relationships elaborately.

The Epidemiological, Clinical, and Therapeutic Profile of Bipolar Patients in Eastern Morocco

INTRODUCTION

 Bipolar disorder is a severe psychiatric disorder. The objective of our study is to describe the epidemiological, clinical, and therapeutic profile of patients followed for bipolar disorder in this hospital.

MATERIALS AND METHODS

This is a cross-sectional, descriptive study conducted over a period of two years within the mental health and psychiatric diseases department of the Mohammed VI University Hospital in Oujda, Morocco, including 206 patients followed for bipolar disorder on an outpatient basis or hospitalized in one of the departments of the hospital.

RESULTS

We included in our study 206 patients with an average age of 37.34+/-12.53 and a male predominance. About 17% of our patients reported a personal medical history and 18.4%, a personal surgical history. Regarding the family history, 40.3% have a medical and surgical history and 63.1%, a psychiatric family history. The consumption of psychoactive substances is present in 49.5% of our patients. About 26.7% reported psychological trauma during childhood. Our patients have reported a history of suicide attempts with a prevalence of 26.6% in several settings: depressive (15%), delusional (5.8%), hallucinatory (3.9%), and anxious (1.9%). Several means were used during these suicide attempts, in particular, defenestration (40%), drug ingestion (36.4%), caustic ingestion (16.4%), strangulation (16.4%), and hanging (10.9%).

CONCLUSION

 It is important to develop a personalized approach to the patient wherever possible and, if necessary, to involve other specialists in diagnosis and treatment.