Neural mechanisms of childhood-onset bipolar illness

2000 ◽  
Vol 12 (3) ◽  
pp. 139-143
Author(s):  
R.M. Post ◽  
G.S. Leverich ◽  
A.M. Speer ◽  
G. Xing ◽  
S.R.B. Weiss
Keyword(s):  
Sexual Abuse ◽  
Maternal Separation ◽  
Suicide Attempts ◽  
Early Recognition ◽  
Bipolar Affective Disorder ◽  
Childhood Onset ◽  
Course Of Illness ◽  
Bipolar Illness ◽  
Axis I ◽  
The Impact

ABSTRACTSubstantial evidence exists for a cohort effect (earlier onset and increased prevalence) for both unipolar and bipolar affective disorder in every generation born since World War II. This effect could be related to inherited mechanisms (e.g., bi-Hneal pedigrees or genetic anticipation) or to environmental/experiential effects on gene expression (e.g., stressor effects on the induction of transcription and growth factors, enzymes, hormones and their receptors, and signal transduction molecules) as documented in preclinical models of neonatal maternal separation.This laboratory evidence is summarized and new clinical data on the impact of severe stressors on the unfolding course of bipolar illness are noted. The reported occurrence of childhood or adolescent physical or sexual abuse, compared to those who report their absence, is associated with: earlier bipolar illness onset; faster cycling (including ultradian) patterns; increased Axis I and II comorbidities; and increased time ill in a prospective year of follow-up. Selectively, physical abuse was associated with a reported pattern of increasingly severe mania and sexual abuse with increased numbers of serious suicide attempts.In a retrospective survey of parents of children with an approximate average age of 13 who were diagnosed with bipolar illness (compared to those with other diagnoses and those with no diagnosis), a cluster of symptoms related to irritability and dyscontrol differentiated the bipolar children earliest. These symptoms included: temper tantrums, irritability, inattention, hyperactivity, impulsivity, poor frustration tolerance, and increased aggression.Given the growing evidence that episodes of affective dysfunction can not only convey morbidity and mortality, but may also sensitize to further recurrence and thus change the course of illness, opportunities abound for early recognition and intervention in childhood onset bipolar illness. Such a successful endeavor would both allow a more normal psychobiological development and allow the possibility of preventing the unfolding of more full-blown bipolar illness altogether.

Father-perpetrators of child sexual abuse who commit suicide

1990 ◽  
Vol 7 (2) ◽  
pp. 144-145 ◽  
Author(s):  
Geraldine Walford ◽  
Marie-Therese Kennedy ◽  
Morna K. C Manwell ◽  
Noel McCune
Keyword(s):  
Sexual Abuse ◽  
Child Sexual Abuse ◽  
Sexually Abused ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Recent Letter ◽  
The Family ◽  
Sex Offences ◽  
The Guardian ◽  
The Impact

Two cases of fathers who committed suicide following the revelation that they had sexually abused their own or other children, are described. The importance of being alert to the possibility of suicide and suicidal acts by family members following a disclosure, is emphasised. Improved liaison and co-ordination between agencies working with these families may enable vulnerable cases to be more readily identified and consequently offered appropriate support and treatment.The revelation that the father in a family has sexually abused his own or other children often precipitates a crisis within the family. The distress suffered by the children themselves and by their mothers is well documented. (Browne and Finkelhor, Hildebrand and Forbes). Goodwin reported suicide attempts in 11 of 201 families, in which sexual abuse had been confirmed. Eight of the attempts were made by daughter-victims. In three of the five cases of mothers who attempted suicide, the abuse was intrafamilial. The impact on father perpetrators, previously a less well researched field, has been receiving more attention of late. Maisch, in a sample of 63 fathers convicted of incest reported that two fathers subsequently committed suicide. Wild has reported on six cases of suicide and three of attempted suicide by perpetrators following disclosure of child sexual abuse. The Cleveland Inquiry Report mentions one father, charged with several sex offences, who committed suicide while awaiting trial. A recent letter to The Guardian newspaper (18th February 1989) by 11 local paediatricians in that area suggests that there are now two such cases of suicide committed by alleged perpetrators.

scholarly journals Mental health among young adults in prison: The importance of childhood-onset conduct disorder

BJPsych Open ◽  
2017 ◽  
Vol 3 (2) ◽  
pp. 78-84 ◽  
Author(s):  
Björn Hofvander ◽  
Henrik Anckarsäter ◽  
Märta Wallinius ◽  
Eva Billstedt
Keyword(s):  
Mental Health ◽  
Young Adults ◽  
Conduct Disorder ◽  
Psychiatric Disorders ◽  
Violent Offenders ◽  
Childhood Onset ◽  
Important Indicator ◽  
Health Burden ◽  
Axis I ◽  
The Impact

BackgroundThe psychiatric health burden of prisoners is substantial. However, there is a lack of high-quality studies of psychiatric disorders among young adults with a high risk of reoffending.AimsTo investigate the lifetime prevalence of psychiatric disorders and use of mental health services among young male violent offenders and the impact of childhood-onset conduct disorder (COCD).MethodA nationally representative cohort (n = 270, age 18–25) of male offenders was followed back in medical records and clinically assessed by gold standard methods. Lifetime prevalences are presented together with odds ratios (ORs) as risk estimates in relation to COCD.ResultsPrevious use of psychiatric services among the participants was high but their lifetime psychiatric morbidity was even higher, with 93% meeting criteria for at least one Axis I disorder. The COCD group was overrepresented in most clinical categories and carried five times higher odds (OR = 5.1, 95% CI 2.0–12.8) of a psychotic disorder, three times higher odds (OR = 3.2, 95% CI 1.2–8.5) of a substance use disorder and two times higher odds of a mood disorder (OR = 2.3, 95% CI 1.3–4.0) or anxiety disorder (OR = 2.0, 95% CI 1.1–3.5).ConclusionsThe mental health burden is substantial among young violent offenders, and COCD is an important indicator of future mental health problems which must be a priority for public health efforts.

Burden experienced by care-givers of persons with bipolar affective disorder

1999 ◽  
Vol 175 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Deborah Perlick ◽  
Robert R. Rosenheck ◽  
John F. Clarkin ◽  
Jo Anne Sirey ◽  
Patrick Raue ◽  
...  
Keyword(s):  
Bipolar Affective Disorder ◽  
Family Care ◽  
Clinical State ◽  
Care Giver ◽  
Illness Beliefs ◽  
Family Control ◽  
Bipolar Illness ◽  
Care Givers ◽  
Multivariate Relationships ◽  
The Impact

BackgroundFamily members of patients with schizophrenia frequently report burdens associated with caring for their relatives.AimsWe evaluate the impact of illness beliefs on the burden reported by family care-givers of people with bipolar illness.MethodThe multivariate relationships between patient symptomatology and family illness beliefs and report of burden were examined at baseline among care-givers of 266 patients with Research Diagnostic Criteria-diagnosed bipolar illness who were subsequently followed for 15 months.ResultsAt baseline, 93% of care-givers reported moderate or greater distress in at least one burden domain. As a group, care-giver illness beliefs (illness awareness, perception of patient and family control) explained an additional 18–28% of variance in burden experienced beyond the effects of the patients clinical state and history.ConclusionsCare-givers of patients with bipolar illness report widespread burden that is influenced by beliefs about the illness.

Complicated Grief and Suicidality: The Impact of Subthreshold Mood Symptoms

CNS Spectrums ◽  
2011 ◽  
Vol 16 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Liliana Dell'Osso ◽  
Claudia Carmassi ◽  
Paola Rucci ◽  
Antonio Ciapparelli ◽  
Ciro Conversano ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Attempts ◽  
Complicated Grief ◽  
Self Report ◽  
Diagnostic And Statistical Manual ◽  
Mood Symptoms ◽  
Axis I Disorders ◽  
Axis I ◽  
The Impact ◽  
The Relationship

AbstractIntroductionThe aim of the present study was to explore the relationship between subthreshold mood symptoms and suicidality in patients with complicated grief (CG).MethodsFifty patients with CG were included in the study and evaluated by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis-I disorders, the Inventory of Complicated Grief, and the Mood Spectrum Self Report (MOODS-SR) lifetime version, to evaluate the subthreshold mood symptoms.ResultsTwenty-eight patients (56%) reported lifetime suicidal ideation and 11 patients (22%) reported suicide attempts. Subthreshold depressive and rhythmicity/vegetative functions items of the MOODS-SR were significantly associated with increased suicidal ideation and attempts, while subthreshold manic items were associated with suicidal ideation only. Relationships were confirmed after controlling for Axis-I disorders comorbidity.ConclusionThe results of the present study suggest the usefulness of exploring lifetime subthreshold mood symptoms in CG patients, in order to promptly identify those who may be more prone to suicidality.

scholarly journals Incidence of childhood-onset bipolar illness in the USA and Europe

2008 ◽  
Vol 192 (2) ◽  
pp. 150-151 ◽  
Author(s):  
Robert M. Post ◽  
David A. Luckenbaugh ◽  
Gabriele S. Leverich ◽  
Lori L. Altshuler ◽  
Mark A. Frye ◽  
...  
Keyword(s):  
Sexual Abuse ◽  
Family History ◽  
Age At Onset ◽  
Familial Risk ◽  
Childhood Adversity ◽  
First Episode ◽  
Childhood Onset ◽  
Bipolar Illness ◽  
The Us ◽  
The Usa

SummaryThe relative incidence of childhood-onset bipolar illness in the USA compared with that in Europe is controversial. We examined this issue in more than 500 out-patients (average age 42 years) with bipolar illness who reported age at onset of first episode, family history, and childhood physical or sexual abuse. Childhood or adolescent onset of bipolar illness was reported by 61% of those in the US cohort but by only 30% of those in The Netherlands or Germany. In the USA there was also twice the incidence of childhood adversity and genetic/familial risk for affective disorder. The findings deserve replication and further exploration.

Developmental vulnerabilities to the onset and course of bipolar disorder

2001 ◽  
Vol 13 (3) ◽  
pp. 581-598 ◽  
Author(s):  
ROBERT M. POST ◽  
GABRIELE S. LEVERICH ◽  
GUOQIANG XING ◽  
SUSAN R. B. WEISS
Keyword(s):  
Early Recognition ◽  
Stress Hormones ◽  
Axis Ii ◽  
Bipolar Illness ◽  
Causative Agents ◽  
History Of ◽  
Axis I ◽  
Acute Changes ◽  
Drug And Alcohol

Different types of psychosocial stressors have long been recognized as potential precipitants of both unipolar and bipolar affective episodes and the causative agents in posttraumatic stress disorder (PTSD). New preclinical data have revealed some of the neurobiological mechanisms that could convey the long-term behavioral and biochemical consequences of early stressors. Depending on the timing, quality, quantity, and degree of repetition, maternal deprivation stress in the neonatal rodent can be associated with lifelong anxiety-like behaviors, increases in stress hormones and peptides, and proneness to drug and alcohol administration, in association with acute changes in the rate of neurogenesis and apoptosis (preprogrammed cell death) and decrements in neurotrophic factors and signal transduction enzymes necessary for learning and memory. Patients with bipolar illness who have a history of early extreme adversity (physical or sexual abuse in childhood or adolescence), compared with those without, show an earlier onset of illness, faster cycling frequencies, increased suicidality, more Axis I and Axis II comorbidities (including alcohol and substance abuse), and more time ill in more than 2 years of prospective follow-up. These findings are subject to a variety of interpretations, but to the extent that the more severe course of bipolar illness characteristics are directly and causally related to these early stressful experiences, early recognition and treatment of high-risk children could be crucial in helping to prevent or ameliorate the long-term adverse consequences of these stressors.

Investigating the Relationship Between Self-Esteem and Stigma Among Young Adults With History of Suicide Attempts

Crisis ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 265-270 ◽  
Author(s):  
Meshan Lehmann ◽  
Matthew R. Hilimire ◽  
Lawrence H. Yang ◽  
Bruce G. Link ◽  
Jordan E. DeVylder
Keyword(s):  
Young Adults ◽  
Suicide Attempts ◽  
Self Esteem ◽  
High Risk Population ◽  
High Functioning ◽  
People With Mental Illness ◽  
History Of ◽  
The Individual ◽  
The Impact ◽  
The Relationship

Abstract. Background: Self-esteem is a major contributor to risk for repeated suicide attempts. Prior research has shown that awareness of stigma is associated with reduced self-esteem among people with mental illness. No prior studies have examined the association between self-esteem and stereotype awareness among individuals with past suicide attempts. Aims: To understand the relationship between stereotype awareness and self-esteem among young adults who have and have not attempted suicide. Method: Computerized surveys were administered to college students (N = 637). Linear regression analyses were used to test associations between self-esteem and stereotype awareness, attempt history, and their interaction. Results: There was a significant stereotype awareness by attempt interaction (β = –.74, p = .006) in the regression analysis. The interaction was explained by a stronger negative association between stereotype awareness and self-esteem among individuals with past suicide attempts (β = –.50, p = .013) compared with those without attempts (β = –.09, p = .037). Conclusion: Stigma is associated with lower self-esteem within this high-functioning sample of young adults with histories of suicide attempts. Alleviating the impact of stigma at the individual (clinical) or community (public health) levels may improve self-esteem among this high-risk population, which could potentially influence subsequent suicide risk.

Suicidal Behavior in Patients with Adjustment Disorders

Crisis ◽  
2001 ◽  
Vol 22 (3) ◽  
pp. 125-131 ◽  
Author(s):  
Ludmila Kryzhanovskaya ◽  
Randolph Canterbury
Keyword(s):  
Personality Disorder ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Adjustment Disorder ◽  
Adjustment Disorders ◽  
Involuntary Hospitalization ◽  
Axis Ii ◽  
The Past ◽  
Substance Abuse Disorders ◽  
Axis I

Summary: This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.

Suicidal Behavior and Non-Suicidal Self-Injury in Emergency Departments Underestimated by Administrative Claims Data

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 318-325 ◽  
Author(s):  
Barbara Stanley ◽  
Glenn W. Currier ◽  
Megan Chesin ◽  
Sadia Chaudhury ◽  
Shari Jager-Hyman ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Suicide Attempts ◽  
The United States ◽  
Administrative Claims ◽  
Suicide Attempters ◽  
Self Injury ◽  
Axis I ◽  
Ed Visits ◽  
External Causes ◽  
Severe Psychopathology

Abstract. Background: External causes of injury codes (E-codes) are used in administrative and claims databases for billing and often employed to estimate the number of self-injury visits to emergency departments (EDs). Aims: This study assessed the accuracy of E-codes using standardized, independently administered research assessments at the time of ED visits. Method: We recruited 254 patients at three psychiatric emergency departments in the United States between 2007 and 2011, who completed research assessments after presenting for suicide-related concerns and were classified as suicide attempters (50.4%, n = 128), nonsuicidal self-injurers (11.8%, n = 30), psychiatric controls (29.9%, n = 76), or interrupted suicide attempters (7.8%, n = 20). These classifications were compared with their E-code classifications. Results: Of the participants, 21.7% (55/254) received an E-code. In all, 36.7% of research-classified suicide attempters and 26.7% of research-classified nonsuicidal self-injurers received self-inflicted injury E-codes. Those who did not receive an E-code but should have based on the research assessments had more severe psychopathology, more Axis I diagnoses, more suicide attempts, and greater suicidal ideation. Limitations: The sample came from three large academic medical centers and these findings may not be generalizable to all EDs. Conclusion: The frequency of ED visits for self-inflicted injury is much greater than current figures indicate and should be increased threefold.

Suicide Attempts Among Depressed Inpatients with Depressive Disorder in a Malaysian Sample

Crisis ◽  
2011 ◽  
Vol 32 (5) ◽  
pp. 283-287 ◽  
Author(s):  
L. F. Chan ◽  
T. Maniam ◽  
A. S. Shamsul
Keyword(s):  
Risk Factors ◽  
Suicidal Ideation ◽  
Suicide Attempt ◽  
Depressive Disorder ◽  
Suicide Attempts ◽  
Psychosocial Risk Factors ◽  
Psychosocial Risk ◽  
Life Event ◽  
Axis I ◽  
A Current

Background: Depressed inpatients constitute a high-risk population for suicide attempts. Aims: To describe the interactions of clinical and psychosocial risk factors influencing suicide attempts among a Malaysian sample of depressed inpatients. Methods: Seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck’s Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. Results: A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. Conclusions: The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors.

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