Factors associated with lifetime suicide attempts: findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

Factors associated with lifetime rapid cycling in bipolar disorder: Findings from the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study)

BACKGROUND

There is a lack of information about factors associated with Bipolar disorder (BD), Rapid Cycling (RC) course in the Indian context.

AIM

This study aimed to evaluate the prevalence and factors associated with BD-RC course using data from the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study).

METHODOLOGY

This was a secondary analysis of data obtained from the BiD-CoIN study to evaluate the factors associated with RC in bipolar disorder.

RESULTS

Out of the 773 patients, about 6 % of BD patients have RC in their lifetime. Factors associated with RC included: being unemployed/homemakers (p < 0.001), being non-Hindus (p = 0.001), longer duration of episodes (p < 0.001), higher number of total and depressive episodes (in a lifetime, per year of illness, first five years, and per year of illness in first five years) (p < 0.001), higher number of manic, hypomanic, and mixed episodes (in the lifetime and per year of illness), shorter duration of current remission (p = 0.01), higher severity of depressive episodes in a lifetime, higher depressive affective morbidity index (p < 0.001), lower severity of manic episodes (p = 0.003), higher level of overall disability (p = 0.01) and in the interpersonal relationship domain, more frequent first-lifetime episode of depressive polarity, more frequent breakthrough episodes (p = 0.001), seasonality of episodes (p < 0.001), suicidal attempts (p = 0.003), relapses due to poor medication adherence (p = 0.003), indeterminate predominant polarity, psychotic symptoms during episodes in a lifetime, higher likelihood of receiving lithium.

CONCLUSIONS

The prevalence of BD-RC course is lower compared to Western countries, but there are many similarities in the factors associated with RC in bipolar disorder between India and Western countries.

Long-Acting Injectable Antipsychotics in Adolescents with Bipolar Disorder

Background: Bipolar disorder often begins in adolescence or early adulthood, characterized by recurrent manic episodes that can lead to neurodegenerative brain changes and functional decline. While several oral second-generation antipsychotics are Food and Drug Administration (FDA)-approved for mania, adherence to maintenance treatment is frequently poor due to factors such as anosognosia, cognitive dysfunction, impulsivity, side effects aversion, and substance use. Long-acting injectable (LAI) antipsychotics, approved for adults with bipolar mania or schizoaffective disorder (bipolar type), offer a potential solution for adolescents with similar conditions. This study reports on the efficacy of LAI antipsychotics in managing bipolar mania in adolescents, tracking outcomes over up to a year with baseline and follow-up Young Mania Rating Scale (YMRS) assessments. Methods: The study included 116 adolescents with a mean age of 16.17 years (66% male, 48% white, 23% black). Of these, 73% were diagnosed with bipolar mania and 22% with schizoaffective disorder, bipolar type. The mean illness duration was 1.9 years, with a baseline YMRS score of 33.8 and a body mass index (BMI) of 23.4 kg/m². LAI antipsychotics administered included aripiprazole, paliperidone, and risperidone, given at intervals of 1, 2, or 3 months. Results: YMRS scores showed substantial improvement, declining to 21.7 at 1 month, 12.3 at 2 months, 4.9 at 6 months, and 3.0 at 1 year. Common side effects were increased appetite and weight gain (mean BMI rose to 26.3 kg/m²). There were no dropouts, although 12% of participants switched formulations due to side effects. Notably, 86.2% of adolescents improved sufficiently to return to school or work. While 28.4% experienced depressive episodes, there were no suicide attempts or deaths during the 4- to 14-month follow-up. Discussion: This study demonstrates that LAI antipsychotics can effectively stabilize adolescents with bipolar mania or schizoaffective disorder, bipolar type, showing a marked decline in YMRS scores and high rates of remission and functional recovery. Despite the lack of FDA approval for LAI antipsychotics in those younger than 18, our results from off-label use suggest significant efficacy and tolerability. Further FDA clinical trials are needed to explore LAI antipsychotic formulations in adolescents to address the needs of this high-risk, nonadherent population.

Factors associated with seasonal affective disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

BACKGROUND

There is a lack of information on the long-term course and outcomes of bipolar disorder (BD) patients with seasonal affective disorder (SAD).

AIM

To compare the demographic and clinical profile of BD patients with and without SAD.

METHODOLOGY

Data from 773 BD patients with an illness duration of at least 10 years were collected from 14 tertiary care centers. SAD was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Participants with and without SAD were compared for demographic and clinical features.

RESULTS

The prevalence of SAD was 9.44 %. BD patients with SAD spent more time in episodes (p < 0.001), had a higher number of lifetime episodes (p < 0.001), and more episodes per year of illness in the lifetime. They also spent more time in depressive episodes (p < 0.001), had higher depressive (p < 0.001) and manic (p = 0.01) affective morbidity indices, shorter durations of current remission (p < 0.001), higher levels of residual depressive and manic symptoms, higher levels of disability, and received more medications (p < 0.001). Patients with SAD were also more likely to have BD-II (p = 0.01), rapid cycling (p < 0.001), a first-lifetime episode of depressive polarity (p = 0.01), a history of breakthrough episodes (p < 0.001), self-discontinuation of pharmacoprophylaxis, and relapses due to poor medication adherence. They were more often receiving lithium, antipsychotics, and antidepressants. However, a lower proportion of those with SAD had been hospitalized, received electroconvulsive therapy, or were receiving valproate.

CONCLUSION

Patients with SAD, in general, have more severe BD, and differ from those without SAD on many clinical parameters.

The prevalence and clinical correlates of suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: Results from a national survey in China

BACKGROUND AND AIM

Suicide is nearly always associated with underlying mental disorders. Risk factors for suicide attempts (SAs) in patients with bipolar disorder (BD) misdiagnosed with major depressive disorder (MDD) remain unelucidated. This study was to evaluate the prevalence and clinical risk factors of SAs in Chinese patients with BD misdiagnosed with MDD.

METHODS

A total of 1487 patients with MDD from 13 mental health institutions in China were enrolled. Mini International Neuropsychiatric Interview (MINI) was used to identify patients with BD who are misdiagnosed as MDD. The general sociodemographic and clinical data of the patients were collected and MINI suicide module was used to identify patients with SAs in these misdiagnosed patients.

RESULTS

In China, 20.6% of patients with BD were incorrectly diagnosed as having MDD. Among these misdiagnosed patients, 26.5% had attempted suicide. These patients tended to be older, had a higher number of hospitalizations, and were more likely to experience frequent and seasonal depressive episodes with atypical features, psychotic symptoms, and suicidal thoughts. Frequent depressive episodes and suicidal thoughts during depression were identified as independent risk factors for SAs. Additionally, significant sociodemographic and clinical differences were found between individuals misdiagnosed with MDD in BD and patients with MDD who have attempted suicide.

CONCLUSIONS

This study highlights the importance of accurate diagnosis in individuals with BD and provide valuable insights for the targeted identification and intervention of individuals with BD misdiagnosed as having MDD and those with genuine MDD, particularly in relation to suicidal behavior.

Disability and its correlates among persons with bipolar disorder: Exploratory findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

Aim

This study aimed to evaluate the disability and its correlates in persons with Bipolar Disorder during the remission phase.

Materials and Methods

As part of the multicentric study, 773 patients with bipolar disorder, currently in clinical remission, were evaluated for disability on the Indian Disability Assessment Evaluation Scale.

Results

About one-fifth of the participants had some level of disability in the domain of self-care, one-third had some level of disability in the interpersonal domain, one-fourth had some level of disability in communication and understanding, and a maximum proportion (43.7%) had some disability in the domain of work. Overall, about one-fifth (18.4%) were considered to have a benchmark disability (i.e., disability >40%). In terms of correlates, those with a disability had a short duration of current remission, a higher number of manic and mixed episodes, a higher mean number of total episodes, spent more time in the episodes, had lower severity of the depressive episodes, higher residual depressive and manic symptoms, had overall higher manic affective morbidity, had a higher level of cognitive deficits, and had poorer insight.

Conclusion

A significant proportion of patients with bipolar disorder have disability in work domain, and the presence of residual symptoms of either polarity are associated with higher level of disability.