Polypharmacy and suicide attempts in bipolar disorder

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.

Download Full-text

Dissecting clinical heterogeneity of bipolar disorder using multiple polygenic risk scores

10.1101/2020.03.31.20044800 ◽

2020 ◽

Author(s):

Brandon J. Coombes ◽

Matej Markota ◽

J. John Mann ◽

Colin Colby ◽

Eli Stahl ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychiatric Disorders ◽

Suicide Attempts ◽

Risk Scores ◽

Rapid Cycling ◽

Clinical Heterogeneity ◽

Polygenic Risk ◽

Clinical Observations ◽

History Of ◽

Dsm Iv

AbstractBipolar disorder (BD) has high clinical heterogeneity, frequent psychiatric comorbidities, and elevated suicide risk. To determine genetic differences between common clinical sub-phenotypes of BD, we performed a systematic PRS analysis using multiple polygenic risk scores (PRSs) from a range of psychiatric, personality, and lifestyle traits to dissect differences in BD sub-phenotypes in two BD cohorts: the Mayo Clinic BD Biobank (N = 968) and Genetic Association Information Network (N = 1001). Participants were assessed for history of psychosis, early-onset BD, rapid cycling (defined as four or more episodes in a year), and suicide attempts using questionnaires and the Structured Clinical Interview for DSM-IV. In a combined sample of 1969 bipolar cases (45.5% male), those with psychosis had higher PRS for SCZ (OR = 1.3 per S.D.; p = 3e-5) but lower PRSs for anhedonia (OR = 0.87; p = 0.003) and BMI (OR = 0.87; p = 0.003). Rapid cycling cases had higher PRS for ADHD (OR = 1.23; p = 7e-5) and MDD (OR = 1.23; p = 4e-5) and lower BD PRS (OR = 0.8; p = 0.004). Cases with a suicide attempt had higher PRS for MDD (OR = 1.26; p = 1e-6) and anhedonia (OR = 1.22; p = 2e-5) as well as lower PRS for educational attainment (OR = 0.87; p = 0.003). The observed novel PRS associations with sub-phenotypes align with clinical observations such as rapid cycling BD patients having a greater lifetime prevalence of ADHD. Our findings confirm that genetic heterogeneity underlies the clinical heterogeneity of BD and consideration of genetic contribution to psychopathologic components of psychiatric disorders may improve genetic prediction of complex psychiatric disorders.

Download Full-text

Comorbid medical illness in bipolar disorder

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.152249 ◽

2014 ◽

Vol 205 (6) ◽

pp. 465-472 ◽

Cited By ~ 55

Author(s):

Liz Forty ◽

Anna Ulanova ◽

Lisa Jones ◽

Ian Jones ◽

Katherine Gordon-Smith ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Mental Health Disorder ◽

Acute Onset ◽

Medical Illness ◽

Illness Burden ◽

Increased Risk ◽

History Of ◽

Dsm Iv ◽

The Uk

BackgroundIndividuals with a mental health disorder appear to be at increased risk of medical illness.AimsTo examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.MethodParticipants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.ResultsWe found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.ConclusionsBipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.Declarations of interestNone.

Download Full-text

Obesity is associated with previous suicide attempts in bipolar disorder

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2010.00452.x ◽

2010 ◽

Vol 22 (2) ◽

pp. 63-67 ◽

Cited By ~ 23

Author(s):

Fabiano A. Gomes ◽

Márcia Kauer-Sant’Anna ◽

Pedro V. Magalhães ◽

Felice N. Jacka ◽

Seetal Dodd ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Suicide Attempts ◽

University Hospital ◽

Comprehensive Management ◽

History Of ◽

Axis I ◽

Dsm Iv ◽

Bipolar Patients ◽

The University

Gomes FA, Kauer-Sant’Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha Â, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder.Objective:There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder.Methods:Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese.Results:Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06–3.69, p = 0.03) as likely to have a history of suicide attempt(s).Conclusion:Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.

Download Full-text

Functional impairment and previous suicide attempts in bipolar disorder

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2008.00339.x ◽

2008 ◽

Vol 20 (6) ◽

pp. 300-306 ◽

Cited By ~ 10

Author(s):

Adriane R. Rosa ◽

Carolina Franco ◽

Anabel Martínez-Aran ◽

Jose Sánchez-Moreno ◽

Manel Salamero ◽

...

Keyword(s):

Bipolar Disorder ◽

Family History ◽

Functional Impairment ◽

Degrees Of Freedom ◽

Suicide Attempts ◽

Structured Interview ◽

Psychotic Symptoms ◽

History Of ◽

Dsm Iv ◽

Bipolar Patients

Objective:The aim of the present study was to assess the association between previous suicide attempts and functional impairment among euthymic patients with bipolar disorder (BD).Methods:Seventy-one Diagnostic Statistical Manual IV (DSM-IV) patients with BD and 61 healthy volunteers were recruited from the Bipolar Disorder Program at the Clinic Hospital of Barcelona. Patients with (n = 36, 50.7%) and without (n = 35, 49.3%) previous suicide attempts were assessed using the Structured Clinical Interview for DSM-IV-TR (SCID-P). Previous suicide attempts were carefully investigated by means of patient and caregiver interview and by a standard structured interview from the protocol of our BD Program. The Functioning Assessment Short Test (FAST) was employed to assess functional impairment.Results:Euthymic patients with previous suicide attempts showed functional impairment, particularly in occupational (F = 30.39; p = 0.001) and cognitive functioning (F = 18.43; p = 0.001). In addition, family history of psychiatric illness (χ2: 6.49; degrees of freedom (df) = 2;132; p = 0.010), family history of affective disorders (χ2 = 5.57; p = 0.017), psychotic symptoms (χ2 = 5.88; p = 0.014) and axis II comorbidity were associated with previous suicide attempts (χ2 = 5.16; p = 0.021).Conclusion:Bipolar patients with previous suicide attempts had lower overall functioning than patients who did not attempt suicide. Previous suicide attempts were particularly associated with the occupational and cognitive domains of functioning.

Download Full-text

Cognitive impact in bipolar disorder

Archives of Depression and Anxiety ◽

10.17352/2455-5460.000042 ◽

2019 ◽

pp. 052-058

Author(s):

Bourin Michel

Keyword(s):

Bipolar Disorder ◽

Verbal Memory ◽

Visual Memory ◽

Age Of Onset ◽

Cognitive Difficulties ◽

Speed Of Information Processing ◽

History Of ◽

Bipolar Patients ◽

Disability Severity ◽

Depressive Episodes

It appears that bipolar patients suffer from cognitive difficulties whereas they are in period of thymic stability. These intercritical cognitive difficulties are fairly stable and their severity is correlated with the functional outcome of patients. Nevertheless, the profile of cognitive impairment varies significantly from study to study quantitatively and qualitatively. According to the studies, the authors find difficulties in terms of learning, verbal memory, visual memory, working memory, sustained attention, speed of information processing, functions executive. On the other hand, deficits of general intelligence, motor functions, selective attention, and language are not usually found. One of the reasons for the heterogeneity of results is the difficulty of exploring cognition in bipolar disorder. Many factors must be taken into account, such as the presence of residual mood symptoms, the longitudinal history of the disorder (age of onset, number of episodes due, among others, the neurotoxic impact of depressive episodes and deleterious cognitive effects). (length of hospitalization), level of disability severity, comorbidities (particularly addictive).

Download Full-text

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

Journal of Affective Disorders ◽

10.1016/j.jad.2011.10.018 ◽

2012 ◽

Vol 136 (3) ◽

pp. 1212-1215 ◽

Cited By ~ 31

Author(s):

Stephanie Moor ◽

Marie Crowe ◽

Sue Luty ◽

Janet Carter ◽

Peter R. Joyce

Keyword(s):

Bipolar Disorder ◽

Young People ◽

Suicide Attempts ◽

Age Of Onset ◽

Early Age

Download Full-text

Comorbid Bipolar Disorder and Borderline Personality Disorder and History of Suicide Attempts

Journal of Personality Disorders ◽

10.1521/pedi_2013_27_122 ◽

2014 ◽

Vol 28 (3) ◽

pp. 358-364 ◽

Cited By ~ 24

Author(s):

Mark Zimmerman ◽

Jennifer Martinez ◽

Diane Young ◽

Iwona Chelminski ◽

Theresa A. Morgan ◽

...

Keyword(s):

Bipolar Disorder ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Suicide Attempts ◽

Borderline Personality ◽

History Of

Download Full-text

Self-Reported Child Maltreatment, History of Suicide Attempts and Surface Area in Adults With Bipolar Disorder

Biological Psychiatry ◽

10.1016/j.biopsych.2020.02.1124 ◽

2020 ◽

Vol 87 (9) ◽

pp. S441

Author(s):

Lejla Colic ◽

Anjali Sankar ◽

Alexis Clark ◽

Durga J. Rathi ◽

Danielle Goldman ◽

...

Keyword(s):

Bipolar Disorder ◽

Child Maltreatment ◽

Surface Area ◽

Suicide Attempts ◽

History Of

Download Full-text

Bipolar disorder first episode and suicidal behavior: are there differences according to type of suicide attempt?

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462009000200006 ◽

2009 ◽

Vol 31 (2) ◽

pp. 114-118 ◽

Cited By ~ 15

Author(s):

Fernando Silva Neves ◽

Leandro Fernandes Malloy-Diniz ◽

Izabela Guimarães Barbosa ◽

Paulo Marcos Brasil ◽

Humberto Corrêa

Keyword(s):

Bipolar Disorder ◽

Logistic Regression ◽

Suicidal Behavior ◽

Suicide Attempts ◽

First Episode ◽

Mean Square ◽

Suicide Attempters ◽

Lifetime History ◽

Bipolar Ii ◽

History Of

OBJECTIVE: The objective of this study was to test the hypothesis that the polarity of the first mood episode may be a marker for suicidal behavior, particularly the violent subtype. METHOD: One hundred and sixty-eight patients diagnosed with bipolar disorder (DSM-IV) were grouped according to type of first episode: depression or manic/hypomanic. Groups were compared for demographic and clinical variables. We performed logistic regression in order to test the association between first episode polarity and suicidal behavior. RESULTS: We found that depressed patients have a lifetime history of more suicide attempts. However, univariate analysis of number of suicide attempts showed that the best model fits the bipolar II subtype (mean square = 15.022; p = 0.010) and lifetime history of psychotic episodes (mean square = 17.359; p = 0.021). Subgrouping the suicide attempts by subtype (violent or non-violent) revealed that manic/hypomanic patients had a greater tendency toward attempting violent suicide (21.2 vs. 14.7%, X² = 7.028, p = 0.03). Multiple logistic regression analysis confirmed this result. CONCLUSION: Depressed patients had more suicide attempts over time, which could be explained by the higher prevalence of bipolar II subtype in this group, whereas manic/hypomanic patients had a lifelong history of more frequent violent suicide attempts, not explained by any of the variables studied. Our results support the evidence that non-violent suicide attempters and violent suicide attempters tend to belong to different phenotypic groups.

Download Full-text