Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts

Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory, revised version (TCI-R). The sample was divided into two groups on the basis of a positive history for suicidal attempts and the suicidal group was further divided into two subgroups according to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamental characteristics are associated with violent suicide attempts, suggesting the importance of affective temperaments in the clinical management of patients with BPI.

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Lifetime history of suicide attempts is associated with poorer social skills in patients with bipolar disorder type I

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462010000200021 ◽

2010 ◽

Vol 32 (2) ◽

pp. 200-201 ◽

Cited By ~ 2

Author(s):

Cristiana Castanho de Almeida Rocca ◽

Luciana Gerchmann ◽

Lena Nabuco de Abreu ◽

Beny Lafer

Keyword(s):

Bipolar Disorder ◽

Social Skills ◽

Suicide Attempts ◽

Type I ◽

Lifetime History ◽

History Of ◽

Disorder Type

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History of suicide attempts in patients with bipolar disorder type I: socio-demographic and clinical factors, quality of life and functioning

Nordic Journal of Psychiatry ◽

10.1080/08039488.2020.1853230 ◽

2020 ◽

pp. 1-8

Author(s):

Vitor Fernandes de Almeida ◽

Severino Bezerra-Filho ◽

Paula Studart-Bottó ◽

Gabriela Léda-Rego ◽

Ivã Taiuan Fialho Silva ◽

...

Keyword(s):

Quality Of Life ◽

Bipolar Disorder ◽

Suicide Attempts ◽

Type I ◽

Clinical Factors ◽

History Of ◽

Disorder Type

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Prevalence of bipolar disorder in a sample of older adults

Scientia Medica ◽

10.15448/1980-6108.2017.4.28026 ◽

2017 ◽

Vol 27 (4) ◽

pp. 28026

Author(s):

Luísa Weber Bisol ◽

Letícia Rodrigues Porciúncula ◽

Elisa Fasolin Mello ◽

Eduardo Lopes Nogueira ◽

Irênio Gomes ◽

...

Keyword(s):

Older Adults ◽

Bipolar Disorder ◽

Suicide Attempt ◽

Suicide Risk ◽

Suicide Attempts ◽

Categorical Variables ◽

Elderly Subjects ◽

Type I ◽

Type Ii ◽

History Of

***Prevalence of bipolar disorder in a sample of older adults***AIMS: To estimate the prevalence of bipolar disorder in a sample of older adults and to examine associated socio-demographic and clinical factors.METHODS: Cross-sectional population-based study of individuals aged 60 years or older registered with the Family Health Strategy in Porto Alegre, Rio Grande do Sul, Brazil, selected randomly from 30 different basic health units. Participants were subjected to diagnostic assessment for bipolar disorder and suicide risk using the Mini International Neuropsychiatric Interview Plus 5.0.0. Categorical variables were described as absolute and relative frequencies. Quantitative variables were expressed as means and standard deviations. The Pearson chi-square or Fisher’s exact tests were used as appropriate to evaluate potential associations between the independent variables suicide attempt and risk of suicide. To control for possible confounders and assess variables independently associated with the outcome of interest, the strength association among different risk factors was assessed by means of prevalence ratios, which were estimated with a controlled Poisson model or multivariate Poisson regression. The significance level was set at 5% (p≤0.05).RESULTS: The sample comprised 550 older adults. The lifetime prevalence of bipolar disorder in the sample was 5.8% and the point prevalence was 1.5%. In those with bipolar disorder, 59.4% were type I and 40.6% type II. Significant associations were observed between bipolar disorder regardless of type and female gender (prevalence rate [PR] 2.42, 95% confidence interval [CI] 1.01-5.81), living with a partner (PR 2.52, 95%CI 1.21-5.24), history of suicide attempt (PR 3.16, 95%CI 1.53-6.25), and suicide risk (PR 2.98, 95%CI 1.47-6.06). When analyzed each type of bipolar disorder, statistically significant associations were found between age under 70 years and type I bipolar disorder; having companion and type II bipolar disorder; and risk of suicide was associated with both types of bipolar disorder.CONCLUSIONS: Regardless of the type of bipolar disorder, women and those living with a partner were more affected. History of suicide attempts and suicide risk were more frequent in elderly subjects with bipolar disorder than in those without the disorder.

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Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462009005000003 ◽

2009 ◽

Vol 31 (3) ◽

pp. 271-280 ◽

Cited By ~ 54

Author(s):

Lena Nabuco de Abreu ◽

Beny Lafer ◽

Enrique Baca-Garcia ◽

Maria A. Oquendo

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Suicidal Ideation ◽

Suicidal Behavior ◽

Suicide Ideation ◽

Suicide Attempts ◽

Clinical Samples ◽

Type I ◽

History Of ◽

Axis I

OBJECTIVE: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. METHOD: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. RESULTS: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59% of the patients have suicide ideation and 25-56% present at least one suicide attempt during lifetime. Approximately 15% to 19% of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis I and Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. CONCLUSION: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior.

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

Crisis ◽

10.1027/0227-5910/a000399 ◽

2016 ◽

Vol 37 (4) ◽

pp. 265-270 ◽

Cited By ~ 10

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.

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Component resolved diagnostics in peanut sensitized children with and without a history of clinical reaction

Allergy and Asthma Proceedings ◽

10.2500/aap.2020.41.200061 ◽

2020 ◽

Vol 41 (5) ◽

pp. 336-340

Author(s):

Yasmin Hamzavi Abedi ◽

Cristina P. Sison ◽

Punita Ponda

Keyword(s):

Retrospective Chart Review ◽

Clinical History ◽

Specific Ige ◽

Exact Test ◽

Ara H 1 ◽

Sige Level ◽

History Of ◽

Laboratory Procedures ◽

Ige Mediated ◽

The Relationship

Background: Serum Peanut-specific-IgE (PN-sIgE) and peanut-component-resolved-diagnostics (CRD) are often ordered simultaneously in the evaluation for peanut allergy. Results often guide the plans for peanut oral challenge. However, the clinical utility of CRD at different total PN-sIgE levels is unclear. A commonly used predefined CRD Ara h2 cutoff value in the literature predicting probability of peanut challenge outcomes is 0.35kUA/L. Objective: To examine the utility of CRD in patients with and without a history of clinical reactivity to peanut (PN). Methods: This was a retrospective chart review of 196 children with PN-sIgE and CRD testing, of which, 98 patients had a clinical history of an IgE-mediated reaction when exposed to PN and 98 did not. The Fisher's exact test was used to assess the relationship between CRD and PN-sIgE at different cutoff levels, McNemar test and Gwet’s approach (AC1 statistic) were used to examine agreement between CRD and PN-sIgE, and logistic regression was used to assess differences in the findings between patients with and without reaction history. Results: Ara h 1, 2, 3, or 9 (ARAH) levels ≤0.35 kUA/L were significantly associated with PN-sIgE levels <2 kUA/L rather than ≥2 kUA/L (p < 0.0001). When the ARAH threshold was increased to 1 kUA/L and 2 kUA/L, these thresholds were still significantly associated with PN-sIgE levels of <2, <5, and <14 kUA/L. These findings were not significantly different in patients with and without a history of clinical reactivity. Conclusion: ARAH values correlated with PN-sIgE. Regardless of clinical history, ARAH levels are unlikely to be below 0.35, 1, or 2 kUA/L if the PN-sIgE level is >2 kUA/L. Thus, if possible, practitioners should consider PN-sIgE rather than automatically ordering CRD with PN-sIgE every time. Laboratory procedures that allow automatically and reflexively adding CRD when the PN-sIgE level is ≤5 kUA/L can be helpful. However, further studies are needed in subjects with challenge-proven PN allergy.

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Frontolimbic brain volume abnormalities in bipolar disorder with suicide attempts

10.1101/2020.05.07.20093245 ◽

2020 ◽

Author(s):

Mbemba Jabbi ◽

Wade Weber ◽

Jeffrey Welge ◽

Fabiano Nery ◽

Maxwell Tallman ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Suicide Attempts ◽

The United States ◽

Anterior Cingulate ◽

Type I ◽

Brain Volumes ◽

Major Health Problem ◽

Dorsolateral Prefrontal

ABSTRACTOver 2.3 million people in the United States live with bipolar disorder. Sixty percent of those with a bipolar disorder diagnosis attempt suicide at least once in their lifetime, and up to 19% die by suicide. However, the neurobiology of suicide attempts in bipolar disorder remains unclear. Here, we studied the neuroanatomical basis for suicide attempt history in bipolar disorder by measuring gray matter volumes (GMV) to identify differences in brain-volumes in 121 participants with bipolar disorder type I, and healthy participants (n=40). The bipolar group consisted of individuals with suicide attempt history (n=23) and no suicide attempt history (n=58). All participants completed behavioral/diagnostic assessments and MRI measures of GMV. We focused on a predefined frontolimbic circuitry in bipolar disorder versus (vs.) healthy to first identify diagnostic GMV markers and to specifically identify markers for suicide attempt history. We found reduced GMV markers for bipolar diagnosis (i.e., bipolar<healthy) in the anterior cingulate cortex (ACC), and dorsolateral prefrontal cortices (DLPFC). Our observed frontolimbic GMV abnormalities were associated with suicide attempt history and measures of individual variations in current suicidal ideation at the time of scanning. These results identified a frontolimbic-GMV marker for bipolar diagnosis and suicidal behavioral risk tendencies.HighlightsSuicide is a major health problem especially in bipolar disorder but the neurobiological basis for suicide attempts remains obscure. We identified an anterior cingulate and dorsolateral prefrontal cortical volume correlate for suicide attempt history and suicidal ideation and thereby demonstrates a convergent brain marker for suicidal behaviors.

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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.

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Study of Risk Factors Associated with Suicide Attempt in Patients with Bipolar Disorder Type I

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1709347 ◽

2020 ◽

Vol 11 (02) ◽

pp. 291-298

Author(s):

Karthick Subramanian ◽

Vikas Menon ◽

Siddharth Sarkar ◽

Vigneshvar Chandrasekaran ◽

Nivedhitha Selvakumar

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Logistic Regression ◽

Family History ◽

Suicide Attempt ◽

Coping Strategies ◽

Binary Logistic Regression ◽

Type I ◽

Factors Associated ◽

History Of

Abstract Background Suicide is the leading contributor to mortality in bipolar disorder (BD). A history of suicidal attempt is a robust predictive marker for future suicide attempts. Personality profiles and coping strategies are the areas of contemporary research in bipolar suicides apart from clinical and demographic risk factors. However, similar research in developing countries is rarer. Objectives The present study aimed to identify the risk factors associated with suicidal attempts in BD type I (BD-I). Materials and Methods Patients with BD-I currently in clinical remission (N = 102) were recruited. Sociodemographic details and the clinical data were collected using a semistructured pro forma. The psychiatric diagnoses were confirmed using the Mini-International Neuropsychiatric Interview 5.0. The National Institute of Mental Health–Life Chart Methodology Clinician Retrospective Chart was used to chart the illness course. Presumptive Stressful Life Events Scale, Coping Strategies Inventory Short Form, Buss–Perry aggression questionnaire, Past Feelings and Acts of Violence, and Barratt Impulsivity scale were used to assess the patient’s stress scores, coping skills, aggression, violence, and impulsivity, respectively. Statistical Analysis Descriptive statistics were used for demographic details and characteristics of the illness course. Binary logistic regression analyses were performed to identify the predictors for lifetime suicide attempt in BD-I. Results A total of 102 patients (males = 49 and females = 53) with BD-I were included. Thirty-seven subjects (36.3%) had a history of suicide attempt. The illness course in suicide attempters more frequently had an index episode of depression, was encumbered with frequent mood episodes, especially in depression, and had a higher propensity for psychiatric comorbidities. On binary logistic regression analysis, the odds ratios (ORs) for predicting a suicide attempt were highest for positive family history of suicide (OR: 13.65, 95% confidence interval [CI]: 1.28–145.38, p = 0.030), followed by the presence of an index depressive episode (OR: 6.88, 95% CI: 1.70–27.91, p = 0.007), and lower scores on problem-focused disengagement (OR: 0.72, 95% CI: 0.56–0.92, p = 0.009). Conclusion BD-I patients with lifetime suicide attempt differ from non-attempters on various course-related and temperamental factors. However, an index episode depression, family history of suicide, and lower problem-focused engagement can predict lifetime suicide attempt in patients with BD-I.

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