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Mood Disorders

Links:

Depressive disorders

Bipolar disorders: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001924/

Research articles:

Altamura A, Dell’Osso B, Berlin H, Buoli M, Bassetti R, Mundo E. (2010). Duration of untreated illness and suicide in bipolar disorder: A naturalistic study. European Archives of Psychiatry & Clinical Neuroscience, 260(5):385-391. Retrieved from Academic Search Premier.

The aim of this naturalistic study was to evaluate the potential influence of the duration of untreated illness (DUI)—defined as the time elapsed between the occurrence of the first mood episode and the first adequate pharmacological treatment with mood stabilizers—on the clinical course of bipolar disorder (BD). Three hundred and twenty outpatients ( n = 320) with a DSM-IV diagnosis of BD—either Type I or Type II—were interviewed; their clinical features were collected and they were naturalistically followed-up for 5 years. At the end of the follow-up observation, the sample was subdivided into two groups: one group with a DUI ≤2 years ( n = 65) and another group with a DUI >2 years ( n = 255). The main demographic and clinical variables were analyzed and compared between the two subgroups of patients using chi-square tests for dichotomous variables or Mann–Whitney U tests for continuous variables. Patients with a longer DUI showed a higher frequency of suicide attempts ( Z = −2.11, P = 0.035), a higher number of suicide attempters (χ2 = 4.13, df = 1, P = 0.04), and a longer duration of illness ( Z = −6.79, P < 0.0001) when compared to patients with a shorter DUI. Moreover, patients with a longer DUI had a depressive first episode more frequently than patients with a shorter DUI (χ2 = 11.28, df = 2, P = 0.004). A further analysis performed dividing the total sample into two subgroups on the basis of a DUI of 6 years (corresponding to the median value of the DUI in the study sample) confirmed prior findings. Results indicate a potential association between a longer DUI and a worse outcome in BD, particularly in terms of suicidality, and confirm the clinical relevance of early diagnosis and pharmacological intervention with mood stabilizers in BD. [ABSTRACT FROM AUTHOR]

Balázs, J., Benazzi, F., Rihmer, Z., Rihmer, A., Akiskal, K. K., & Akiskal, H. S. (2006). The close link between suicide attempts and mixed (bipolar) depression: Implications for suicide prevention. Journal of Affective Disorders, 91(2-3), 133-138. doi:10.1016/j.jad.2005.12.049

Background: Previous reports have shown a significant relationship between suicide ideation and mixed depression. The aim of this study was to explore the prevalence and clinical characteristics of mixed depression among non-violent suicide attempters. Methods: Using a structured interview (modified Mini International Neuropsychiatric Interview) and assessing all the symptoms of 16 psychiatric diagnoses, the authors examined 100 consecutive nonviolent suicide attempters (aged 18-65) within 24 h after their attempts. Mixed depression was defined as a major depressive episode (MDE)/dysthymic disorder plus 3 or more co-occurring hypomanic symptoms, according to the definition validated by Akiskal and Benazzi [Akiskal, H.S., Benazzi, F., 2003a. Delineating depressive mixed states: Their therapeutic significance. Clin. Approaches Bipolar Disord. 2, 41-47, Akiskal, H.S., Benazzi, F., 2003b. Family history validation of the bipolar nature of depressive mixed states. J. Affect. Disord. 73, 113-122.]. Results: Current mixed depression was present in 63.0% in the total sample, and in 70.8% among the 89 depressive suicide attempters. Irritability, distractibility and psychomotor agitation were present in more than 90% of the subjects with mixed depression. The rate of mixed depression was significantly higher among bipolar than non-bipolar depressive suicide attempters (90% vs. 62%). Patients with mixed depression had the following concurrent disorders: bipolar disorders 41.0%, panic disorder 30.0%, generalized anxiety disorder 89.0%, alcohol abuse/dependence 56.0%, and substance abuse 27.0%. Mixed depression versus non-mixed depression had the following significant associations (odds ratio=OR): females 2.4, bipolar II disorder 9.3, generalized anxiety disorder 41.3, irritability 101.6 and psychomotor agitation 61.1. Limitations: The study didn't include suicide attempters with very high risk of fatality. Conclusions: The important new finding of this study is the very high prevalence of mixed depression among depressed suicide attempters. The rates of mixed depression among bipolar and non-bipolar depressive suicide attempters were much higher than previously reported among nonsuicidal bipolar II and unipolar depressive outpatients, suggesting that suicide attempters come mainly from mixed depressives with predominantly bipolar II base. Irritability and psychomotor agitation were the strongest predictors of suicide attempt. From a public health standpoint, our data highlight the necessity of detecting and treating mixed (bipolar) depression in the prevention of suicidal behaviour. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Cassidy, F. (2011). Risk factors of attempted suicide in bipolar disorder. Suicide & Life-Threatening Behavior, 41, 6-11. doi:10.1111/j.1943-278X.2010.00007.x

Suicide rates of bipolar patients are among the highest of any psychiatric disorder, and improved identification of risk factors for attempted and completed suicide translates into improved clinical outcome. Factors that may be predictive of suicidality in an exclusively bipolar population are examined. White race, family suicide history, and history of cocaine abuse were predictive of suicidal histories. Gender, nicotine use, medical comorbidity, and history of alcohol and other drug abuse were not, although a trend was noted for a history of benzodiazepine abuse. Attempts, although less common among African Americans, were equally as violent. Likewise, attempts were as violent among females as males, in distinction to general population studies.

Ilgen, M. A., Bohnert, A. B., Ignacio, R. V., Mccarthy, J. F., Valenstein, M. M., Kim, M., & Blow, F. C. (2010). Psychiatric diagnoses and risk of suicide in veterans. Archives of General Psychiatry, 67(11), 1152-1158. doi:10.1001/archgenpsychiatry.2010.129

Context: Although numerous studies have documented the clear link between psychiatric conditions and suicide, few have allowed for the comparison between the strength of association between different psychiatric diagnoses and suicide. Objective: To examine the strength of association between different types of psychiatric diagnoses and the risk of suicide in patients receiving health care services from the Department of Veterans Affairs in fiscal year (FY) 1999. Design: This project examined National Death Index data and Veterans Health Administration patient treatment records. Setting: Department of Veterans Affairs, Veterans Health Administration. Participants: All veterans who used Veterans Health Administration services during FY 1999 (N=3 291 891) who were alive at the start of FY 2000. Main Outcome Measures: Psychiatric diagnoses were obtained from patient treatment records in FY 1998 and 1999 and used to predict subsequent death by suicide during the following 7 years in sex-stratified survival analyses controlling for age. Results: In the 7 years after FY 1999, 7684 veterans died by suicide. In diagnosis-specific analyses, patients with bipolar disorder had the greatest estimated risk of suicide among men (hazard ratio, 2.98; 95% confidence interval, 2.73-3.25), and patients with substance use disorders had the greatest risk among women (6.62; 4.72- 9.29). Conclusions: Although all the examined psychiatric diagnoses were associated with elevated risk of suicide in veterans, results indicate that men with bipolar disorder and women with substance use disorders are at particularly elevated risk for suicide. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Kelly, E., & Sharma, V. (2010). Diagnosis and treatment of postpartum bipolar depression. Expert Review Of Neurotherapeutics, 10(7), 1045-1051. Retrieved from EBSCOhost.

The postpartum period is a time of increased risk of new-onset psychiatric illness, hospital admissions and out-patient psychiatric care for new mothers. Research into postpartum mood disorders has focused primarily on major depressive disorder, and has overlooked the study of bipolar disorder, particularly bipolar II disorder and bipolar disorder not otherwise specified. Failure to properly diagnose postpartum bipolar disorder may delay the initiation of appropriate treatment, lead to inappropriate treatment - thereby precipitating (hypo)mania, rapid cycling or a mixed episode - or result in polypharmacy and treatment refractoriness. The most serious consequence, however, is the high risk of infanticide and suicide among women with postpartum bipolar disorder. While no specific screening tools have been validated for postpartum mania or bipolar depression, symptoms of hypomania, atypical depression, a family history of bipolar disorder and a rapid onset of depressive symptoms following delivery may suggest a bipolar diathesis. In the absence of any pharmacological or psychotherapeutic treatments to guide clinical decision-making, it is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of non-postpartum bipolar depression, using medications that are compatible with lactation.

MacLean, J., Kinley, D., Jacobi, F., Bolton, J. M., & Sareen, J. (2011). The relationship between physical conditions and suicidal behavior among those with mood disorders. Journal of Affective Disorders, 130(1/2), 245-250. doi:10.1016/j.jad.2010.10.028

Abstract: Background: There has recently been increased interest in the relationship between physical illness, mental illness, and suicide. The present study utilizes a large community-based sample to investigate the association between certain physical conditions and suicidal behavior, among those with a history of a mood disorder. Methods: Data came from the nationally representative German Health Survey (N=4181, age 18–65). Physical conditions were assessed by a general practice physician. DSM-IV mental disorders were assessed using a modified version of the Composite International Diagnostic Interview. Among those with a lifetime mood disorders, suicidal ideation, plans, and attempts were assessed by self-report. Multiple logistic regression analyses were used to examine the association between physical conditions and suicidal behavior among those with a history of mood disorder. Results: Anxiety and substance use disorders were significantly positively associated with suicidal behavior [OR 1.61, 95% CI 1.13–2.31 and 2.01, 95% 1.34–3.00, respectively]. After adjusting for anxiety and substance use disorders as well as sociodemographic variables, respiratory illness, hypertension, and number of physical disorders were significantly associated with suicidal behavior [AORs 1.72, 1.68, and 1.16, respectively]. Limitations: The findings of this study are limited to adults with a history of a mood disorder. Personality disorders were not assessed. Conclusion: The present study suggests that among people with mood disorder, respiratory illnesses, hypertension, and number of physical conditions are associated with suicidal behavior independent of the effects of comorbid mental illness. Clinicians should recognize the contributing risk of physical health problems to suicidal behavior. [Copyright &y& Elsevier]

Nogueira, V. V., Valente, J. J., Soares, M. J., Pereira, A. T., Maia, B. B., Marques, M. M., & ... Azevedo, M. H. (2011). P01-237 - Suicidal behaviour in bipolar disorder. European Psychiatry, 26, 238. doi:10.1016/S0924-9338(11)71948-4

Introduction: Bipolar Disorder is a serious, common and disabling mental disorder which is associated to high morbidity and high suicide attempt rates. Objectives: To identify clinical and social-demographic variables associated to suicidal behaviour in Bipolar Disorder. Methods: The samples comprises 124 patients (62.1% females) diagnosed with Bipolar Disorder (ICD-10 diagnosis following DIGS/OPCRIT). The variables selected to the analysis were extracted from DIGS and OPCRIT. Results: Suicidal behaviour occurs in 27.1% of the patients; the most used method was voluntary drug poisoning; it''s more frequent in females, with males using more violent methods - remaining results still unavailable. Conclusions: This study identifies several clinical and social-demographic variables that can help the clinician to delineate a suicidal profile among his Bipolar patients, hence improving his ability to develop an early intervention plan and suicide prevention strategies. [Copyright &y& Elsevier]

Pendse, B., Engström, G., & Träskman-Bendz, L. (2004). Psychopathology of seasonal affective disorder patients in comparison with major depression patients who have attempted suicide. The Journal Of Clinical Psychiatry, 65(3), 322-327. Retrieved from EBSCOhost.

Background: Few studies have compared the psychopathology of patients with seasonal and nonseasonal mood disorders. Method: We compared the psychopathology of a consecutively referred sample of seasonal affective disorder (SAD) outpatients (N = 87) with that of hospitalized suicide attempters who had nonseasonal major depression (N = 65) by using the Comprehensive Psychopathological Rating Scale (CPRS). Diagnoses were made according to DSM-III-R criteria. Data were gathered from October 1992 to April 1996. Results: There were no significant differences in the CPRS total scores of all of the observed items or of the depression subscale items between the groups. The SAD sample had significantly (p <.05) higher scores on 18 reported non-psychotic items than the non-SAD suicide attempters. Eleven CPRS items were independently associated with SAD in a backward logistic regression analysis: the reported items were hostile feelings, indecision (negatively), lassitude, failing memory, increased sleep, muscular tension, loss of sensation or movement, and disrupted thoughts, and the observed items were perplexity, slowness of movement (negatively), and agitation. Conclusion: As compared with non-SAD suicide attempters with major depression, SAD patients have an abundant symptomatology, reflected especially by scores on self-reported items.

Pendse, B. G., Öjehagen, A. A., Engström, G. G., & Träskman-Bendz, L. L. (2003). Social characteristics of seasonal affective disorder patients: Comparison with suicide attempters with non-seasonal major depression and other mood disorder patients. European Psychiatry, 18(1), 36. doi:10.1016/S0924-9338(02)00007-X

Although it is evident from numerous studies that patients with mood disorders generally have a deficient social functioning and a weak social network, little is known about these aspects of seasonal affective disorder (SAD) patients. We studied the social situation, the social network and the social functioning of SAD (n = 20) patients in comparison with matched suicide attempters (SA) with non-seasonal major depression, and with findings from other major depressive disorder (MDD) studies and community samples. The social situation and the clinical background of both the SAD and the SA groups were almost similar and the social networks were equally disadvantageous and weaker than those observed in some community/healthy populations. Furthermore, the data on global functioning and social adjustment of the SAD group were well comparable to those of other MDD patients and significantly worse than that of a community sample. Thus, the results indicate a considerable social impairment in SAD. [Copyright &y& Elsevier]

Quevedo, L., da Silva, R., Coelho, F., Pinheiro, K., Horta, B., Kapczinski, F., & Pinheiro, R. (2011). Risk of suicide and mixed episode in men in the postpartum period. Journal of Affective Disorders, 132(1/2), 243-246. doi:10.1016/j.jad.2011.01.004

Abstract: Objectives: To assess suicide risk in men with mood disorders at the postpartum period. Methods: We conduct a longitudinal study with 650 men whose child has born from April 2007 to May 2008 at maternity hospital. The first assessment was in the antenatal period and the second within 30 to 60days postpartum. Suicide risk, anxiety disorders, hypomanic, manic and mixed episodes were assessed by the Mini International Neuropsychiatric Interview (MINI). Results: The prevalence of suicide risk in fathers in postpartum was of 4.8%. Fathers with postpartum depression were 20.97 (CI: 5.74; 76.53) more likely to present suicide risk and those with mixed episodes showed a chance of 46.50 (CI: 10.52; 205.53) times higher than those who did not suffer from any mood disorder. Conclusion: Mixed episodes are common in fathers at postpartum, posing a higher suicide risk than depressive and manic/hypomanic episodes. Therefore, in order to reduce the suicide risk, clinicians should address and treat adequately mixed affective states in this specific population. [Copyright &y& Elsevier]

Sánchez-Gistau, V. V., Colom, F. F., Mané, A. A., Romero, S. S., Sugranyes, G. G., & Vieta, E. E. (2009). Atypical depression is associated with suicide attempt in bipolar disorder. Acta Psychiatrica Scandinavica, 120(1), 30-36. doi:10.1111/j.1600-0447.2008.01341.x

Objective: There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out-patients. Method: Variables were defined according to DSM-IV criteria, and assessed with a Structured Interview for DSM-IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non-attempters were compared using univariate and multivariate analysis. Results: Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. Conclusion: Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies. [ABSTRACT FROM AUTHOR]

Sani, G., Tondo, L., Koukopoulos, A., Reginaldi, D., Kotzalidis, G. D., Koukopoulos, A. E., & ... Tatarelli, R. (2011). Suicide in a large population of former psychiatric inpatients. Psychiatry & Clinical Neurosciences, 65(3), 286-295. doi:10.1111/j.1440-1819.2011.02205.x

The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric inpatients receiving retrospective and prospective DSM-IV diagnoses. We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35-year period in a private hospital setting. We collected sociodemographic, clinical and temperamental data. Ninety-six patients from the sample committed suicide. There were no sex differences in suicide completion and no differences between major psychiatric disorders, but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression. Shorter-term treatment with lithium and anticonvulsants, longer-term treatment with antidepressants, history of suicide attempts, suicidal thinking, and single status positively predicted completed suicide. Suicide tended to occur after a mean period of about 14 years of duration of disease. Patients' symptoms during the period preceding suicide were assessed through interviewing patients' physicians or family members. Symptoms occurring in >10% of cases were, in decreasing order, inner tension, racing/crowded thoughts, aggressive behavior, guilt, psychomotor agitation, persecutory ideation, anxiety, and hallucinations. Surprisingly, cyclothymic temperament was less associated with completed suicide as compared to other temperaments. Suicide is likely to occur in a milieu of agitation, mixed anxiety and depression, and psychosis. Longer-term mood stabilizer treatment may reduce the rate of completed suicide. [ABSTRACT FROM AUTHOR]

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