Effects of comorbidity and early age of onset in young people with Bipolar Disorder on self harming behaviour and suicide attempts

BackgroundWhite matter (WM) impairments have been reported in patients with bipolar disorder (BD) and those at high familial risk of developing BD. However, the distribution of these impairments has not been well characterized. Few studies have examined WM integrity in young people early in the course of illness and in individuals at familial risk who have not yet passed the peak age of onset.MethodWM integrity was examined in 63 BD subjects, 150 high-risk (HR) individuals and 111 participants with no family history of mental illness (CON). All subjects were aged 12 to 30 years.ResultsThis young BD group had significantly lower fractional anisotropy within the genu of the corpus callosum (CC) compared with the CON and HR groups. Moreover, the abnormality in the genu of the CC was also present in HR participants with recurrent major depressive disorder (MDD) (n = 16) compared with CON participants.ConclusionsOur findings provide important validation of interhemispheric abnormalities in BD patients. The novel finding in HR subjects with recurrent MDD – a group at particular risk of future hypo/manic episodes – suggests that this may potentially represent a trait marker for BD, though this will need to be confirmed in longitudinal follow-up studies.

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Prospective rates of suicide attempts and nonsuicidal self-injury by young people with bipolar disorder participating in a psychotherapy study

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867415622268 ◽

2015 ◽

Vol 50 (2) ◽

pp. 167-173 ◽

Cited By ~ 5

Author(s):

Maree L Inder ◽

Marie T Crowe ◽

Suzanne E Luty ◽

Janet D Carter ◽

Stephanie Moor ◽

...

Keyword(s):

Bipolar Disorder ◽

Young People ◽

Suicide Attempts ◽

Self Injury ◽

Nonsuicidal Self Injury

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Risk factors for suicide behaviors in bipolar disorder: A closer look

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.381 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S421-S421

Author(s):

D. Durães ◽

J. Martins ◽

R. Borralho

Keyword(s):

Risk Factors ◽

At Risk ◽

Bipolar Disorder ◽

Suicide Attempts ◽

Age Of Onset ◽

Mood Episode ◽

Pubmed Database ◽

Patients At Risk ◽

Suicide Behaviors ◽

Risk Factors For Suicide

IntroductionSuicide behaviors (suicide acts and suicide attempts) are a major concern for clinicians treating patients with psychiatric disorders. Among them, patients with bipolar disorder (BD) have the highest prevalence of suicide behaviors, accounting for up to one-quarter of all completed suicides. Additionally, suicide remains the leading cause of avoidable death in patients with BD.AimsThis work aims to review the main risk factors for suicide behaviors in patients with BD.MethodsThe MEDLINE/Pubmed database was searched using the keywords “bipolar disorder” with: “suicide”; “suicide attempt”; and “suicide risk factors”. Articles published in the last 10 years were considered.ResultsIt is estimated that 25% to 50% of patients with BD will attempt suicide at least once in their lifetime and, that 10% to 15% will die. The risk factors for suicide behaviors in patients with BD have been widely studied and their knowledge is crucial for identifying patients at risk.The main risk factors include previous suicide attempts, family history of suicide and hopelessness. Other risk factors have also been identified: depressive polarity of first mood episode; rapid cycling; increasing severity of affective episodes; depressive polarity of the latest mood episode; mixed affective states; early age of onset; and comorbid anxiety disorders, substance use disorders and cluster B personality disorders.ConclusionsPrevention of suicide behaviors is crucial when treating patients with BD. Therefore, the knowledge of these risk factors is of extreme importance in order to promptly identify patients at risk and adopt the proper preventive therapeutic interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Impact of Age at Onset on the Long-term Course of Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.093 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S13-S14

Author(s):

R. Kupka

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Age Of Onset ◽

Late Onset ◽

Past History ◽

Age At Onset ◽

Term Outcome ◽

Long Term Outcome ◽

The Impact

IntroductionBipolar disorder (BD) typically starts in adolescence or young adulthood (early-onset; EO-BD), which may have different backgrounds and consequences than late-onset (LO) BD. There are controversies over pre-pubertal age of onset (AoO).ObjectivesTo give an overview of the various concepts of AoO in BD, the impact of AoO on subsequent illness course, and findings of the Stanley Foundation Bipolar Network (SFBN) with relationship to AoO.Methodsliterature review and additional analyses of SFBN database.ResultsBD usually begins with a depressive episode. SFBN-data reveal that an earlier AoO is associated with a less favourable prospective illness course (more depression, mood instability and rapid cycling), longer delay to first treatment, past history of suicide attempts, being abused in childhood abuse, more psychiatric and medical comorbidities. Comparison of the US sample with the European sample of SFBN showed an earlier onset in US patients.Conclusionand early AoF of BD is associated with a poorer long-term outcome, despite adequate current treatment.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Association of the brain-derived neurotrophic factor gene and bipolar disorder with early age of onset in mainland China

Neuroscience Letters ◽

10.1016/j.neulet.2008.01.001 ◽

2008 ◽

Vol 433 (2) ◽

pp. 98-102 ◽

Cited By ~ 41

Author(s):

Jihua Tang ◽

Ling Xiao ◽

Chang Shu ◽

Gaohua Wang ◽

Zhongchun Liu ◽

...

Keyword(s):

Bipolar Disorder ◽

Neurotrophic Factor ◽

Age Of Onset ◽

Mainland China ◽

Brain Derived Neurotrophic Factor ◽

Early Age ◽

Factor Gene ◽

The Brain

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Age of onset in obsessive–compulsive disorder: admixture analysis with a large sample

Psychological Medicine ◽

10.1017/s0033291713000470 ◽

2013 ◽

Vol 44 (1) ◽

pp. 185-194 ◽

Cited By ~ 40

Author(s):

G. E. Anholt ◽

I. M. Aderka ◽

A. J. L. M. van Balkom ◽

J. H. Smit ◽

K. Schruers ◽

...

Keyword(s):

Bipolar Disorder ◽

Obsessive Compulsive Disorder ◽

Age Of Onset ◽

Late Onset ◽

Early Age ◽

Admixture Analysis ◽

Adhd Symptoms ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Co Morbidity

BackgroundResearch into age of onset in obsessive–compulsive disorder (OCD) has indicated significant differences between patients with early and late onset of the disorder. However, multiple criteria have been used arbitrarily for differentiating between early- and late-onset OCD, rendering inconsistent results that are difficult to interpret.MethodIn the current study, admixture analysis was conducted in a sample of 377 OC patients to determine the number of underlying populations of age of onset and associated demographic and clinical characteristics. Various measures of anxiety, depression, co-morbidity, autism, OCD, tics and attention deficit hyperactivity disorder (ADHD) symptoms were administered.ResultsA bimodal age of onset was established and the best-fitting cut-off score between early and late age of onset was 20 years (early age of onset ⩽19 years). Patients with early age of onset were more likely to be single. Early age of onset patients demonstrated higher levels of OCD severity and increased symptoms on all OCD dimensions along with increased ADHD symptoms and higher rates of bipolar disorder.ConclusionsIt is suggested that 20 years is the recommended cut-off age for the determination of early versus late age of onset in OCD. Early age of onset is associated with a generally graver OCD clinical picture and increased ADHD symptoms and bipolar disorder rates, which may be related to greater functional implications of the disorder. We propose that age of onset could be an important marker for the subtyping of OCD.

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Suicidal behavior is four times more frequent in university students with bipolar disorder assessed by an online version of Mood Disorder Questionnaire

GSC Advanced Research and Reviews ◽

10.30574/gscarr.2020.5.1.0086 ◽

2020 ◽

Vol 5 (1) ◽

pp. 030-042

Author(s):

Luiz Henrique Costa Neto ◽

Kévia Maria Rodrigues de Sousa ◽

Aliny Hellen Lima Pinheiro ◽

Dhynne Kelley Lima de Menezes ◽

Samara Fonseca Frota ◽

...

Keyword(s):

Bipolar Disorder ◽

Young People ◽

University Students ◽

Mood Disorder ◽

Suicidal Behavior ◽

Suicide Attempts ◽

Private Universities ◽

Online Version ◽

Worth Living ◽

Mood Disorder Questionnaire

Introduction: Bipolar disorder (BD) in young people is frequently associated with suicidal behavior. The main objective of this research is to evaluate if university students who have BD show more suicidal behavior than those who do not have BD. Materials and Methods: 583 university students from Fortaleza, Brazil, participated in this study. Volunteers over 18 years of age who were attending public or private universities from March to December 2019 were able to participate. A sociodemographic and clinical questionnaire and the Mood Disorder Questionnaire (MDQ) were filled out. According to MDQ, participants were classified into three groups: 1) individuals without BD (n=318); 2) individuals with subthreshold BD symptoms (n=160); 3) individuals with BD (n=105). Results: Compared to those who do not have BD, individuals with BD had four times less plans for the future (x2=16.00; p=0.000), considered four times life less worth living (x2=13.44; p=0.001), assumed two times more frequently death as welcome if it comes (x2=19.10; p=0.000), thought two times more about getting hurt (x2=75.32; p=0.000), had seven times more specific plans to die (x2=39.93; p=0.000) and had four times more suicide attempts (x2=33.50; p=0.000). Conclusions: Suicidal behavior was four times more prominent in university students with BD than in those who did not have BD.

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Polypharmacy and suicide attempts in bipolar disorder

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462006005000021 ◽

2006 ◽

Vol 29 (1) ◽

pp. 35-38 ◽

Cited By ~ 9

Author(s):

Fernando Kratz Gazalle ◽

Pedro Curi Hallal ◽

Juliana Tramontina ◽

Adriane Ribeiro Rosa ◽

Ana Cristina Andreazza ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Outcome Measure ◽

Age Of Onset ◽

Main Outcome Measure ◽

History Of ◽

Dsm Iv ◽

Multiple Drugs ◽

Socioeconomic Data ◽

Structured Questionnaire

OBJECTIVE: The aim of this study was to assess the association between suicide attempts and the use of multiple drugs in patients with bipolar disorder. METHOD: One hundred sixty-nine bipolar disorder outpatients diagnosed using the DSM-IV Structured Clinical Interview were included. Demographic and socioeconomic data, number of medications currently in use, history of suicide attempts, number of years undiagnosed, age of onset and current psychiatric co-morbidities were assessed using a structured questionnaire and DSM-IV criteria. The main outcome measure was the number of psychotropic drugs currently in use. RESULTS: Approximately half of all patients (48.5%) presented a history of suicide attempt; 84% were using more than one medication, and 19% were using more than three drugs. The most frequent combinations of drugs used by these patients were: lithium + valproate (17%); lithium + antipsychotics (10%); lithium + valproate + antipsychotics (9%); and antidepressants + any drug (6%). The number of suicide attempts was associated with the use of multiple drugs. CONCLUSIONS: Our findings support the notion that the use of combination therapy in bipolar disorder may be related to severity of the BD, such as number of suicide attempts.

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