bipolar disorder non-genetic factors


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(Updated 1/12/04)

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Post RM, Leverich GS, Xing G, Weiss RB.
Developmental vulnerabilities to the onset and course of bipolar disorder.
Dev Psychopathol 2001 Summer;13(3):581-98
"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." [Abstract]

Leverich GS, McElroy SL, Suppes T, Keck PE Jr, Denicoff KD, Nolen WA, Altshuler LL, Rush AJ, Kupka R, Frye MA, Autio KA, Post RM.
Early physical and sexual abuse associated with an adverse course of bipolar illness.
Biol Psychiatry 2002 Feb 15;51(4):288-97
"BACKGROUND: There is growing awareness of the association between physical and sexual abuse and subsequent development of psychopathology, but little is known, however, about their relationship to the longitudinal course of bipolar disorder. METHODS: We evaluated 631 outpatients with bipolar I or II disorder for general demographics, a history of physical or sexual abuse as a child or adolescent, course of illness variables, and prior suicide attempts, as well as SCID-derived Axis I and patient endorsed Axis II comorbidity. RESULTS: Those who endorsed a history of child or adolescent physical or sexual abuse, compared with those who did not, had a history of an earlier onset of bipolar illness, an increased number of Axis I, II, and III comorbid disorders, including drug and alcohol abuse, faster cycling frequencies, a higher rate of suicide attempts, and more psychosocial stressors occurring before the first and most recent affective episode. The retrospectively reported associations of early abuse with a more severe course of illness were validated prospectively. CONCLUSIONS: Greater appreciation of the association of early traumatic experiences and an adverse course of bipolar illness should lead to preventive and early intervention approaches that may lessen the associated risk of a poor outcome." [Abstract]

Hammersley P, Dias A, Todd G, Bowen-Jones K, Reilly B, Bentall RP.
Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation.
Br J Psychiatry. 2003 Jun;182:543-7.
"BACKGROUND: Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder. AIMS: To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder. METHOD: A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive-behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis. RESULTS: A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations. CONCLUSIONS: The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation." [Abstract]

Buka SL, Fan AP.
Association of prenatal and perinatal complications with subsequent bipolar disorder and schizophrenia.
Schizophr Res 1999 Sep 29;39(2):113-9; discussion 160-1
"This paper presents an overview of the recent literature on the association between prenatal and perinatal complications (PPCs) and schizophrenia, then systematically reviews papers published later than 1965 examining the association of PPCs and bipolar disorder. Three of the four studies comparing bipolar cases with normal controls indicated a positive association of PPCs with the development of bipolar disorder in adult life; the four odds ratios ranged from 1.0 to 12.0. The proportion of PPCs among the bipolar samples without comparison subjects ranged from 3.8% to 50.0%. Issues of study design, measurement and severity of exposure, and outcome are addressed. This review suggests that further investigation of genetic interactions, gender differences, and the specificity of effects in the association between PPCs and mental disorders other than schizophrenia is warranted." [Abstract]

Wals M, Reichart CG, Hillegers MH, Van Os J, Verhulst FC, Nolen WA, Ormel J.
Impact of birth weight and genetic liability on psychopathology in children of bipolar parents.
J Am Acad Child Adolesc Psychiatry. 2003 Sep;42(9):1116-21.
"OBJECTIVE: To test different models for ways in which birth weight and familial loading influence the risk for psychopathology in bipolar offspring. METHOD: DSM-IV diagnoses of 140 bipolar offspring (12-21 years of age) were assessed with the K-SADS-PL. Parents were interviewed using the Family History-Research Diagnostic Criteria to determine familial loading of mood and substance use disorders. Parents reported the birth weight of their offspring. Age- and sex-adjusted hazard ratios were calculated. RESULTS: Low birth weight was associated with mood and non-mood disorders in bipolar offspring (hazard ratio = 0.6, confidence interval = 0.4-0.8), even after controlling for familial loading of unipolar disorder, bipolar disorder, or substance use disorder. There were no significant interactions between birth weight and familial loading of unipolar disorder, familial loading of bipolar disorder, and familial loading of substance use disorder. CONCLUSIONS: Birth weight is associated with mood as well as non-mood disorders. This association is independent from the association of familial loading of mood and substance use disorder with mood- and non-mood disorders in bipolar offspring." [Abstract]

Brown AS, van Os J, Driessens C, Hoek HW, Susser ES.
Further evidence of relation between prenatal famine and major affective disorder.
Am J Psychiatry 2000 Feb;157(2):190-5
"OBJECTIVE: In a previous study, the authors demonstrated an association between prenatal famine in middle to late gestation and major affective disorders requiring hospitalization. In this study, they sought to examine the association by using newly identified cases from the Dutch birth cohort used previously to examine the gender specificity of the association and to assess whether this relation is present for both unipolar and bipolar affective disorders. METHOD: The authors compared the risk of major affective disorder requiring hospitalization in birth cohorts who were and were not exposed, in each trimester of gestation, to famine during the Dutch Hunger Winter of 1944-1945. These cases of major affective disorder requiring hospitalization were newly ascertained from a national psychiatric registry. A larger data set from this registry was used for analysis by gender and diagnostic subtype. RESULTS: For the newly ascertained cases, the risk of developing major affective disorder requiring hospitalization was increased for subjects with exposure to famine in the second trimester and was increased significantly for subjects with exposure in the third trimester, relative to unexposed subjects. For the cases from the entire period of ascertainment, the risk of developing affective disorder was significantly increased for those exposed to famine during the second and the third trimesters of gestation. The effects were demonstrated for men and women and for unipolar and bipolar affective disorders. CONCLUSIONS: These results provide support for the authors' previous findings on the association between middle to late gestational famine and affective disorder." [Abstract]

Furukawa TA, Ogura A, Hirai T, Fujihara S, Kitamura T, Takahashi K.
Early parental separation experiences among patients with bipolar disorder and major depression: a case-control study.
J Affect Disord 1999 Jan-Mar;52(1-3):85-91
"BACKGROUND: Although the association between childhood parental loss and later development of mood disorder has received much research interest in the past, the results obtained and conclusions drawn have been various, and inconsistent with each other. The present study aims to examine this old, yet unresolved, question among the Japanese. METHODS: Patients with bipolar disorder (n = 73) and unipolar depression (n = 570) and community healthy controls (n = 122) were examined as to their psychopathology and childhood parental loss experiences with semi-structured interviews. RESULTS: Stratified for sex and age, no statistically significant difference was observed in the incidence of paternal or maternal death or separation before age 16 between bipolar patients and healthy controls. Female patients with unipolar depression under the age of 54 experienced significantly more maternal loss than the corresponding controls. This excess in loss appeared to be largely due to the patients experiencing separation from their mothers. CONCLUSION: Our findings concerning bipolar disorder have replicated the previous two studies reported in the literature. Those concerning unipolar depression appear to be in line with several recent studies on the subject but, as stated, many discrepant findings can also be found in the literature." [Abstract]

Johnson L, Lundstrom O, Aberg-Wistedt A, Mathe AA.
Social support in bipolar disorder: its relevance to remission and relapse.
Bipolar Disord. 2003 Apr;5(2):129-37.
"OBJECTIVES: While an association between low-level social support and depression has been found in many studies, its relevance in bipolar illness has been rarely investigated. The aim of this study was to investigate the effects of social support in the remission and relapse of bipolar disorder. METHODS: We obtained ratings from 94 stabilized bipolar patients using two different questionnaires that measure perceived social support: the Interview Schedule for Social Interaction and the Interpersonal Support Evaluation List. RESULTS: Significantly lower social support was found in patients in partial recovery compared with those in full recovery (p = 0.003). Patients who relapsed during a 1-year prospective follow-up period perceived a significantly lower level of social support than patients with no relapse (p = 0.012). CONCLUSIONS: Bipolar patients with full interepisode remission perceive more social support than those who do not achieve full remission. Poor social support may increase the risk of relapse in bipolar disorder." [Abstract]

Tsuchiya KJ, Byrne M, Mortensen PB.
Risk factors in relation to an emergence of bipolar disorder: a systematic review.
Bipolar Disord. 2003 Aug;5(4):231-42.
"OBJECTIVE: There is a consensus that genetic factors are important in the causation of bipolar disorder (BPD); however, little is known about other risk factors in the aetiology of BPD. Our aim was to review the literature on such risk factors - risk factors other than family history of affective disorders - as predictors for the initial onset of BPD. METHODS: We conducted a literature search using the MEDLINE, PsycINFO and EMBASE databases. We selected factors of interest including demographic factors, factors related to birth, personal, social and family backgrounds, and history of medical conditions. The relevant studies were extracted systematically according to a search protocol. RESULTS: We identified approximately 100 studies that addressed the associations between antecedent environmental factors and a later risk for BPD. Suggestive findings have been provided regarding pregnancy and obstetric complications, winter-spring birth, stressful life events, traumatic brain injuries and multiple sclerosis. However, evidence is still inconclusive. Childbirth is likely to be a risk factor. The inconsistency across studies and methodological issues inherent in the study designs are also discussed. CONCLUSION: Owing to a paucity of studies and methodological issues, risk factors of BPD other than family history of affective disorders have generally been neither confirmed nor excluded. We call for further research." [Abstract]

Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich LA
Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders.
Am J Psychiatry. 2005 Jan;162(1):79-91.
OBJECTIVE: This study ascertained the incidence of complications during pregnancy, labor, and delivery and the neonatal characteristics of infants born to women with schizophrenia, bipolar disorder, or major depression in a population-based cohort. METHOD: Based on records linkage across a psychiatric case register and prospectively recorded obstetric data, the study comprised women with schizophrenia or major affective disorders who had given birth to 3,174 children during 1980-1992 in Western Australia. A comparison sample of 3,129 births to women without a psychiatric diagnosis was randomly selected from women giving birth during 1980-1992. Complications were scored with the McNeil-Sjöström Scale. Odds ratios were calculated for specific reproductive events. RESULTS: Both schizophrenic and affective disorder patients had increased risks of pregnancy, birth, and neonatal complications, including placental abnormalities, antepartum hemorrhages, and fetal distress. Women with schizophrenia were significantly more likely to have placental abruption, to give birth to infants in the lowest weight/growth population decile, and to have children with cardiovascular congenital anomalies. Neonatal complications were significantly more likely to occur in winter; low birth weight peaked in spring. Complications other than low birth weight and congenital anomalies were higher in pregnancies after psychiatric illness than in pregnancies preceding the diagnosis. CONCLUSIONS: While genetic liability and gene-environment interactions may account for some outcomes, maternal risk factors and biological and behavioral concomitants of severe mental illness appear to be major determinants of increases in reproductive pathology in this cohort. Risk reduction in these vulnerable groups may be achievable through antenatal and postnatal interventions. [Abstract]

Hakkarainen R, Johansson C, Kieseppa T, Partonen T, Koskenvuo M, Kaprio J, Lonnqvist J.
Seasonal changes, sleep length and circadian preference among twins with bipolar disorder.
BMC Psychiatry. 2003 Jun 9;3(1):6. Epub 2003 Jun 09.
"BACKGROUND: We aimed at studying the seasonal changes in mood and behaviour, the distribution of hospital admissions by season, and the persistence of the circadian type in twins with bipolar disorder and their healthy co-twins. METHODS: All Finnish like-sex twins born from 1940 to 1969 were screened for a diagnosis of bipolar type I disorder. The diagnosis was assessed with a structured research interview, and the study subjects (n = 67) filled in the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Morningness-Eveningness Questionnaire (MEQ). For studying the persistence of the habitual sleep length and circadian type, we used data derived from the Finnish Twin Cohort Questionnaire (FTCQ). Bipolar twins were compared with their healthy co-twins. RESULTS: Bipolar twins had greater seasonal changes in sleep length (p = 0.01) and mood (p = 0.01), and higher global seasonality scores (p = 0.03) as compared with their co-twins with no mental disorder. Sunny days (p = 0.03) had a greater positive effect on wellbeing in the bipolar than healthy co-twins. CONCLUSIONS: Our results support the view that bipolar disorder is sensitive to the environmental influence in general and to the seasonal effect in specific. Exposure to natural light appears to have a substantial effect on wellbeing in twins with bipolar disorder." [Full Text]

Lee HJ, Kim L, Joe SH, Suh KY.
Effects of season and climate on the first manic episode of bipolar affective disorder in Korea.
Psychiatry Res 2002 Dec 15;113(1-2):151-9
"The first manic episodes out of 152 bipolar disorder patients were investigated, in subjects who were admitted in two hospitals in Seoul between 1996 and 1999. Correlations between the monthly climate variables and the first monthly manic episodes indicated that the first manic episodes peaked in 25 cases during March. The mean monthly hours of sunshine and sunlight radiation correlated significantly with manic episodes. Separating the patients into two groups, namely, with and without major depressive episode, only the occurrence of manic episodes with major depressive episode was significantly correlated with mean monthly hours of sunshine. Separating the subjects by gender, the monthly first manic episodes was significantly correlated with the intensity of sunlight radiation in female patients only. These findings suggested that increasing the duration and intensity of sunlight could facilitate breakdown into the manic episodes." [Abstract]

Schaffer A, Levitt AJ, Boyle M.
Influence of season and latitude in a community sample of subjects with bipolar disorder.
Can J Psychiatry. 2003 May;48(4):277-80.
"OBJECTIVE: To report on the prevalence of seasonal bipolar disorder (BD) and the impact of latitude in a community sample in the province of Ontario. METHOD: This study used the telephone-administered Depression and Seasonality Interview. Exact latitude was determined for each participant. RESULTS: Overall, 14 of 62 (22.6%) subjects with BD had the seasonal subtype of BD. Latitude did not appear to influence the proportion of subjects with the seasonal subtype. CONCLUSIONS: We identified a seasonal pattern of illness in a proportion of subjects with BD." [Abstract]

Nath J, Sagar R.
Late-onset bipolar disorder due to hyperthyroidism.
Acta Psychiatr Scand 2001 Jul;104(1):72-3; discussion 74-5
"OBJECTIVE: Bipolar disorder starts typically in early age and late-onset cases are rare. Late-onset cases are more likely to have comorbid medical illnesses responsible for them. This case report highlights late-onset bipolar disorder due to hyperthyroidism. METHOD: A 65-year-old patient of bipolar disorder has been described. RESULT: Physical examination and laboratory investigations detected presence of hyperthyroidism and the patient was treated with antithyroid and anxiolytics. CONCLUSION: A thorough examination and investigation are required in late-onset cases of bipolar disorder to rule out secondary causes. Definitive antimanic agents or mood stabilizers may not be required in such cases." [Abstract]

Mino Y, Oshima I, Okagami K.
Seasonality of birth in patients with mood disorders in Japan.
J Affect Disord 2000 Jul;59(1):41-6
"BACKGROUND: Findings about seasonality of birth in individuals with mood disorders have been inconsistent. METHODS: Data were collected from the governmental statistics, the Patient Survey in Japan in 1996. The number of patients with mood disorders was 13,969. We obtained information about each patient's date of birth, sex, and diagnosis according to ICD-10. Distributions of monthly birth numbers of patients with mood disorders were compared to those of the general population. RESULTS: Birth excess was observed from winter to early-spring in both sexes, compared to births of the general population. The magnitude of the excess was larger in females than in males. Although the same tendencies were observed in patients with bipolar disorder and depressive disorder, the differences were more marked in females. Limitations: Insufficient birth data in the general population before 1940 and hospital diagnosis. CONCLUSION: Among Japanese patients with mood disorders, there are excess births from winter to early-spring, compared to the general population. This difference is more marked in females than in males." [Abstract]

Khananashvili MM.
[Clinical and prognostic significance of seasonal factor in endogenous maniac states]
Zh Nevrol Psikhiatr Im S S Korsakova. 2002;102(8):14-7.
"The study aimed at determination of clinical and prognostic significance of seasonal factor in endogenous maniac state development. Using clinico-psychopathological and clinical follow-up study, 32 patients (30 women and 2 men) aged 20-50 years with seasonal endogenous mania were examined. Seasonal mania developed in 12 patients with bipolar affective disorder, in 13 patients with schizoaffective psychosis and 7 patients with attack-like schizophrenia (F31.1 - F31.6, F25 and F20.02 + F25 ICD-10 items respectively). Seasonal maniac state was shown to be a significant clinical symptom that might be regarded as a prognostic factor. In patients with bipolar disorder--with a prevalence of both mania and depression-seasonal mania development in autumn-winter period was a favourable prognostic trait, being observed mainly in manic depressive psychosis. In spring-summer mania, prognosis was less favourable and was preferentially found in schizoaffective psychosis and attack-like schizophrenia." [Abstract]

Mortazi M, Bertrand J, Triffaux JM, Troisfontaines B, Kempeneers JL.
[Influence of heredity, sex and season on the type of episode of bipolar disorder]
Rev Med Liege 2002 Mar;57(3):171-5
"The aim of this work was to investigate if sex, age, family history, season and hypothyroidism have any influence on the type of episodes (manic, depressive, mixed) seen in bipolar patients. This retrospective study concerns a sample of 208 patients with a diagnosis of bipolar disorder (type I or II), who were admitted in one of two psychiatric centers between July 1996 and June 2000. The sex-ratio was 2.8 females for 1 male. Sex, family history and hypothyroidism were not associated with any type of episode. A higher percentage of depressive episodes was observed in the patients who were older than 50 and the average age of depressive patients was higher than that of other patients. There was no seasonal pattern in this study and the season did not influence the type of episode. The results indicate no influence of sex, season, family history and hypothyroidism on the type of episode presented. On the opposite, age seems to favour depression episode." [Abstract]

Noaghiul S, Hibbeln JR.
Cross-national comparisons of seafood consumption and rates of bipolar disorders.
Am J Psychiatry. 2003 Dec;160(12):2222-7.
"OBJECTIVE: The authors sought to determine if greater seafood consumption, a measure of omega-3 fatty acid intake, is associated with lower prevalence rates of bipolar disorder in community samples. METHOD: Lifetime prevalence rates in various countries for bipolar I disorder, bipolar II disorder, bipolar spectrum disorder, and schizophrenia were identified from population-based epidemiological studies that used similar methods. These epidemiological studies used structured diagnostic interviews with similar diagnostic criteria and were population based with large sample sizes. Simple linear and nonlinear regression analyses were used to compare these prevalence data to differences in apparent seafood consumption, an economic measure of disappearance of seafood from the economy. RESULTS: Simple exponential decay regressions showed that greater seafood consumption predicted lower lifetime prevalence rates of bipolar I disorder, bipolar II disorder, and bipolar spectrum disorder. Bipolar II disorder and bipolar spectrum disorder had an apparent vulnerability threshold below 50 lb of seafood/person/year. The absence of a correlation between lifetime prevalence rates of schizophrenia and seafood consumption suggests a specificity to affective disorders. CONCLUSIONS: These data describe a robust correlational relationship between greater seafood consumption and lower prevalence rates of bipolar disorders. These data provide a cross-national context for understanding ongoing clinical intervention trials of omega-3 fatty acids in bipolar disorders." [Abstract]

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Recent Bipolar Disorder Non-Genetic Factor Research

1) Álvarez MJ, Roura P, Foguet Q, Osés A, Solŕ J, Arrufat FX
Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness.
J Nerv Ment Dis. 2012 Jun;200(6):549-52.
Traumatic experiences and posttraumatic stress disorder (PTSD) are more frequent in patients with serious mental illness than in the general population. This study included 102 patients with schizophrenia, bipolar disorder, and schizoaffective disorder, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. Epidemiological and clinical data were collected using the Brief Psychiatric Rating Scale and Traumatic Life Events and Distressing Event questionnaires. We found a high number of traumatic experiences, and 15.1% of the patients met all criteria for PTSD. We found no differences based on diagnosis or sex, although there was a nonsignificant trend toward greater PTSD comorbidity in women. Among patients with serious mental illness and PTSD, 64.3% had made some attempt at suicide at some point in life, compared with 37.4% of patients without PTSD. [PubMed Citation] [Order full text from Infotrieve]

2) Dieset I, Hope S, Ueland T, Bjella T, Agartz I, Melle I, Aukrust P, Rřssberg JI, Andreassen OA
Cardiovascular risk factors during second generation antipsychotic treatment are associated with increased C-reactive protein.
Schizophr Res. 2012 Jul 17;
OBJECTIVE: Severe mental disorder and cardiovascular disease (CVD) are often associated, and inflammation is implicated in both disorders. We investigated whether there is a relationship between CVD risk factors and inflammation in schizophrenia or bipolar disorder, and if second generation antipsychotics (SGA) interact. METHODS: We included 361 patients in a naturalistic cross-sectional study, 235 subjects on current SGA treatment and 126 subjects not treated with SGA as controls. Cardiovascular parameters were measured and current medication recorded. Fasting plasma levels of the following cytokines were measured: high sensitivity CRP (hsCRP), soluble tumor necrosis factor receptor 1 (sTNF-R1), osteoprotegerin (OPG), soluble CD40 ligand (sCD40L), interleukin-1 receptor antagonist (IL-1Ra), von Willebrand factor (vWf) and interleukin-6 (IL-6). RESULTS: In this relatively young sample of patients with a mean age of 33.3years, the following CVD risk factors were associated with elevated inflammation markers after adjusting for confounders: BMI, triglycerides and glucose with hsCRP (p=0.041-0.001), HDL-cholesterol and triglycerides with sTNF-R1 (p=0.009-0.001) and triglycerides with vWf (p=0.004). In patients treated with SGA, elevated hsCRP was significantly associated with high BMI (p=0.012), and with high glucose levels (p=0.003). CONCLUSION: Several CVD risk factors are associated with elevated levels of inflammation markers in young patients with severe mental illness. The interaction between SGA and CVD risk factors on hsCRP levels might indicate a specific inflammatory activation related to SGA induced overweight and hyperglycemia. This suggests that hsCRP could be a valuable marker for future cardiovascular events, particularly in patients treated with SGA. [PubMed Citation] [Order full text from Infotrieve]

3) Pappadopulos E, Newcomer JW, Kolluri S
Changes in weight, plasma lipids, and glucose in adults treated with ziprasidone: a comprehensive analysis of pfizer-initiated clinical trials.
J Clin Psychiatry. 2012 Jun;73(6):e742-8.
[PubMed Citation] [Order full text from Infotrieve]

4) Stange JP, Boccia AS, Shapero BG, Molz AR, Flynn M, Matt LM, Abramson LY, Alloy LB
Emotion regulation characteristics and cognitive vulnerabilities interact to predict depressive symptoms in individuals at risk for bipolar disorder: A prospective behavioural high-risk study.
Cogn Emot. 2012 Jul 9;
Recent work has identified behavioural approach system (BAS) sensitivity as a risk factor for the first onset and recurrence of mood episodes in bipolar disorder, but little work has evaluated risk factors for depression in individuals at risk for, but without a history of, bipolar disorder. The present study evaluated cognitive styles and the emotion-regulatory characteristics of emotional clarity and ruminative brooding as prospective predictors of depressive symptoms in individuals with high versus moderate BAS sensitivity. Three separate regressions indicated that the associations between dysfunctional attitudes, self-criticism, and neediness with prospective increases in depressive symptoms were moderated by emotional clarity and brooding. Whereas brooding interacted with these cognitive styles to exacerbate their impact on depressive symptoms, emotional clarity buffered against their negative impact. These interactions were specific to high-BAS individuals for dysfunctional attitudes, but were found across the full sample for self-criticism and neediness. These results indicate that emotion-regulatory characteristics and cognitive styles may work in conjunction to confer risk for and resilience against depression, and that some of these relationships may be specific to individuals at risk for bipolar disorder. [PubMed Citation] [Order full text from Infotrieve]

5) Topiwala A, Hothi G, Ebmeier KP
Identifying patients at risk of perinatal mood disorders.
Practitioner. 2012 May;256(1751):15-8, 2.
Perinatal mental illness influences obstetric outcomes, mother-baby interactions and longer term emotional and cognitive development of the child. Psychiatric disorders have consistently been found to be one of the leading causes of maternal deaths, often through suicide. Postnatal depression and puerperal psychosis are two disorders most commonly associated with the perinatal period. The most efficient strategy to identify patients at risk relies on focussing on clinically vulnerable subgroups: enquiries about depressive symptoms should be made at the usual screening visits. Attention should be paid to any sign of poor self-care, avoidance of eye contact, overactivity or underactivity, or abnormalities in the rate of speech. Particular care should be taken to ask about suicidal ideation and thoughts of harming others, including the baby. One of the most important risk factors is a previous history of depression. The degree of risk is directly correlated with severity of past episodes. Both antenatal and postnatal depression are being increasingly recognised in men. Puerperal psychosis is rare (1 to 2 per 1,000). Sixty per cent of women with puerperal psychosis already have a diagnosis of bipolar disorder or schizoaffective disorder. Women with a personal history of postpartum psychosis or bipolar affective disorder should be considered as high risk for postpartum psychosis. All pregnant women who are identified as being at high risk should have a shared care plan for their late pregnancy and early postnatal psychiatric management. Women with current mood disorder of mild or moderate severity who have a first-degree relative with a history of bipolar disorder or postpartum psychosis should be referred for psychiatric assessment. [PubMed Citation] [Order full text from Infotrieve]

6) Fardet L, Petersen I, Nazareth I
Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care.
Am J Psychiatry. 2012 May;169(5):491-7.
[PubMed Citation] [Order full text from Infotrieve]

7) Gejman PV, Sanders AR
[The etiology of schizophrenia].
Medicina (B Aires). 2012;72(3):227-34.
Research conducted in recent years represents a new dawn of knowledge for the risk factors of schizophrenia, and genome-wide approaches have revolutionized the field of genetic mapping of schizophrenia. The aggregate genetic data increasingly support a combination of rare and common genetic variation in schizophrenia, a major role for polygenic inheritance, and a genetic overlap (pleiotropy) of schizophrenia and other psychiatric disorders, such as bipolar disorder and autism. A main challenge for the field is the translation of established genetic associations into a better pathophysiological understanding of schizophrenia. The current and upcoming resequencing programs - both exomes (all exons) and full genomes - and genome-wide transcriptional analyses will allow a more thorough dissection of the molecular genetics of the disorder. [PubMed Citation] [Order full text from Infotrieve]

8) Gonda X, Pompili M, Serafini G, Montebovi F, Campi S, Dome P, Duleba T, Girardi P, Rihmer Z
Suicidal behavior in bipolar disorder: Epidemiology, characteristics and major risk factors.
J Affect Disord. 2012 Jul 2;
BACKGROUND: Suicide is one of the leading causes of death and a major public health problem worldwide, and the majority of suicide attempters and completers suffer from some major affective disorder at the time of their death, which, in the majority of cases is unrecognized, under- or misdiagnosed and untreated. Methods: Based on a systematic literature search, the authors give a detailed and critical overview of established risk factors of suicide in bipolar disorder. RESULTS: Among affective disorders, bipolar disorder carries the highest risk of suicide, yet not all bipolar patients commit or even attempt suicide during their illness. While the general suicide risk factors also apply for bipolar disorders, there are several disease-specific risk factors as well which should be taken into account when evaluating suicide risk in case of patients. Conclusion: It is crucial to identify suicide risk factors in bipolar disorder to be able to differentiate those patients within this already increased-risk illness group who are at especially high risk and therefore to allow for better prediction and prevention of suicidal acts. [PubMed Citation] [Order full text from Infotrieve]

9) Sullivan PF, Magnusson C, Reichenberg A, Boman M, Dalman C, Davidson M, Fruchter E, Hultman CM, Lundberg M, Lĺngström N, Weiser M, Svensson AC, Lichtenstein P
Family History of Schizophrenia and Bipolar Disorder as Risk Factors for AutismFamily History of Psychosis as Risk Factor for ASD.
Arch Gen Psychiatry. 2012 Jul 2;:1-5.
CONTEXT The clinical and etiologic relation between autism spectrum disorders (ASDs) and schizophrenia is unclear. The degree to which these disorders share a basis in etiology has important implications for clinicians, researchers, and those affected by the disorders. OBJECTIVE To determine whether a family history of schizophrenia and/or bipolar disorder is a risk factor for ASD. DESIGN, SETTING, AND PARTICIPANTS We conducted a case-control evaluation of histories of schizophrenia or bipolar disorder in first-degree relatives of probands in 3 samples-population registers in Sweden, Stockholm County (in Sweden), and Israel. Probands met criteria for ASD, and affection status of parents and siblings for schizophrenia and bipolar disorder were established. RESULTS The presence of schizophrenia in parents was associated with an increased risk for ASD in a Swedish national cohort (odds ratio [OR], 2.9; 95% CI, 2.5-3.4) and a Stockholm County cohort (OR, 2.9; 95% CI, 2.0-4.1). Similarly, schizophrenia in a sibling was associated with an increased risk for ASD in a Swedish national cohort (OR, 2.6; 95% CI, 2.0-3.2) and an Israeli conscription cohort (OR, 12.1; 95% CI, 4.5-32.0). Bipolar disorder showed a similar pattern of associations but of lesser magnitude. CONCLUSIONS Findings from these 3 registers along with consistent findings from a similar study in Denmark suggest that ASD, schizophrenia, and bipolar disorder share common etiologic factors. [PubMed Citation] [Order full text from Infotrieve]

10) McGinty EE, Zhang Y, Guallar E, Ford DE, Steinwachs D, Dixon LB, Keating NL, Daumit GL
Cancer incidence in a sample of Maryland residents with serious mental illness.
Psychiatr Serv. 2012 Jul 1;63(7):714-7.
[PubMed Citation] [Order full text from Infotrieve]

11) Gonda X, Borbély-Ipkovich E, Döme P, Duleba T, Rihmer Z
[Characteristics and risk factors of suicidal behaviour in bipolar disorder].
Psychiatr Hung. 2012;27(2):103-14.
Suicidal behaviour has a complex and multicausal background and poses a challenge not only for psychiatry, but also for medicine in general and the whole society. The majority of suicides are committed by psychiatric - mainly affective disorder - patients, and even within this illness group bipolar disorder patients are at an especially high risk. Therefore among bipolar patients, reducing suicide risk, recognition and prevention of imminent suicide requires the investigation, description and understanding of risk factors, including those specifically associated with bipolar disorders. [PubMed Citation] [Order full text from Infotrieve]

12) Gordon JS, Neyman KM, Wells RD, Chen SC
Drug rash with eosinophilia and systemic symptoms (DRESS syndrome).
Cutis. 2012 Apr;89(4):180-2.
[PubMed Citation] [Order full text from Infotrieve]

13) Soreca I, Wallace ML, Frank E, Hasler BP, Levenson JC, Kupfer DJ
Sleep duration is associated with dyslipidemia in patients with bipolar disorder in clinical remission.
J Affect Disord. 2012 May 11;
BACKGROUND: The pathways to increased cardiovascular risk in bipolar disorder include health behaviors, psychosocial stress and long-term medication exposure. However, the evidence that the association between cardiovascular risk factors and bipolar disorder remains significant after controlling for these co-factors suggests that additional important risk factors have yet to be identified. Our hypothesis is that disturbances in the sleep-wake cycle are an important and under-recognized pathway through which affective disorders lead to increased cardiovascular risk. METHODS: In patients with bipolar disorder type 1 in clinical remission, we: 1) explored whether sleep disturbance predicted the endorsement of NCEP ATP-III criteria for dyslipidemia, independent of other lifestyle factors and 2) tested the association between low HDL (NCEP-ATP III) and sleep duration measured with actigraphy over an eight-day period. RESULTS: Median sleep duration is significantly associated with low HDL. The risk of having low HDL increases by 1.23 with every 30 minutes of reduced sleep time. LIMITATIONS: Since sleep patterns in patients with bipolar disorder are variable and irregular, it is possible that other sleep characteristics, not present during the span of our study, or the variability itself may be what drives the increased cardiovascular risk. CONCLUSIONS: Sleep characteristics of patients with bipolar disorder in clinical remission are associated with cardiovascular risk. More specifically, sleep duration was associated with low HDL. Clinicians should pay special attention to sleep hygiene in treating individuals with bipolar disorder, even when they are in clinical remission. [PubMed Citation] [Order full text from Infotrieve]

14) Ruengorn C, Sanichwankul K, Niwatananun W, Mahatnirunkul S, Pumpaisalchai W, Patumanond J
A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort.
Psychol Res Behav Manag. 2012;5:37-45.
[PubMed Citation] [Order full text from Infotrieve]

15) Boes AD, Grafft A, Espe-Pfeifer P, Rowe J, Stein MT
Manipulative and antisocial behavior in an 11-year-old boy with epilepsy.
J Dev Behav Pediatr. 2012 May;33(4):365-8.
Brian is an 11-year-old boy who presented to the emergency room with suicidal ideation and hearing voices. In the preceding weeks, he had escalating symptoms of oppositional defiant disorder, attention-deficit hyperactivity disorder (ADHD), and bipolar disorder. His medical history was notable for complex partial epilepsy with onset at age 4 that had been well controlled with divalproate. He had several mental health diagnoses by various practitioners including oppositional defiant disorder, ADHD, and bipolar disorder. Brian's family and social history was notable for the absence of identifiable risk factors for seizures or psychiatric problems. Over the course of a week-long psychiatric hospitalization, his complaints of depression and hearing voices seemed incongruent with his behavior. His parents endorsed a long history of Brian manipulating family and friends, such as conning his friends into stealing money and giving it to him. There was increasing suspicion that Brian was contriving his presenting symptoms for secondary gains. When his parents visited, he consistently bargained for prized items such as a long sought after cell phone and his own bedroom to improve his mood. His prior diagnoses (ADHD, a mood disorder, and oppositional defiant disorder) did not capture what seemed to be his core problem--an ability and willingness to manipulate others for his own self-serving purposes. Three months later, he was seen in the pediatric neurology clinic for increased seizure frequency. In the interim, he had several very serious altercations including setting fire to his family church, an attempted break-in-and-entry, assaulting his principal and resisting the arresting officer, and a malicious planned attack on his father where he struck him in the head with a crescent wrench "in cold blood, without any emotion." [PubMed Citation] [Order full text from Infotrieve]

16) Sala R, Goldstein BI, Morcillo C, Liu SM, Castellanos M, Blanco C
Course of comorbid anxiety disorders among adults with bipolar disorder in the U.S. population.
J Psychiatr Res. 2012 Jul;46(7):865-72.
[PubMed Citation] [Order full text from Infotrieve]

17) Acosta FJ, Vega D, Torralba L, Navarro S, Ramallo-Farińa Y, Fiuza D, Hernández JL, Siris SG
Hopelessness and suicidal risk in bipolar disorder. A study in clinically nonsyndromal patients.
Compr Psychiatry. 2012 Apr 13;
OBJECTIVE: Attempted suicide and death due to suicide are not uncommon among patients with bipolar disorder. Although some risk factors for suicidality in bipolar patients have been identified, little is known about hopelessness and other possible trait or diathesis-related factors. Consequently, the objective of this study was to investigate variables associated with suicidal risk in clinically nonsyndromal bipolar patients. METHODS: A sample of 102 outpatients with a diagnosis of bipolar disorder according to International Classification of Diseases, 10th Revision criteria during nonsyndromal stage were evaluated. On the basis of suicidal history, patients were divided into suicide attempt, suicidal ideation, and nonsuicidal groups. Sociodemographic, clinical, and psychopathological variables were assessed. RESULTS: As compared with the nonsuicidal group, female sex, combined psychopharmacologic treatment, and hopelessness were independently associated with suicide attempt. Hopelessness and insight into having a mental disorder were independently associated with history of suicidal ideation. CONCLUSIONS: Patients with bipolar disorder and suicidal history are characterized by the presence of hopelessness, which probably confers greater vulnerability for suicidal behavior in the presence of stress factors. This identification of the risk profile for suicidal behavior in nonsyndromal bipolar patients adds complementary information to risk factors established for suicidality during acute phases of the disease, allows for differentiated preventive and treatment approaches of patients at risk, and suggests psychotherapy as an advisable intervention in this group of patients. [PubMed Citation] [Order full text from Infotrieve]

18) Mühleisen TW, Mattheisen M, Strohmaier J, Degenhardt F, Priebe L, Schultz CC, Breuer R, Meier S, Hoffmann P, Rivandeneira F, Hofman A, Uitterlinden AG, Moebus S, Gieger C, Emeny R, Ladwig KH, Wichmann HE, Schwarz M, Kammerer-Ciernioch J, Schlösser RG, Nenadic I, Sauer H, Mössner R, Maier W, Rujescu D, Lange C, Ophoff RA, Schulze TG, Rietschel M, Nöthen MM, Cichon S
Association between schizophrenia and common variation in neurocan (NCAN), a genetic risk factor for bipolar disorder.
Schizophr Res. 2012 Jun;138(1):69-73.
A recent study found genome-wide significant association between common variation in the gene neurocan (NCAN, rs1064395) and bipolar disorder (BD). In view of accumulating evidence that BD and schizophrenia partly share genetic risk factors, we tested this single-nucleotide polymorphism for association with schizophrenia in three independent patient-control samples of European ancestry, totaling 5061 patients and 9655 controls. The rs1064395 A-allele, which confers risk for BD, was significantly over-represented in schizophrenia patients compared to controls (p=2.28×10(-3); odds ratio=1.11). Follow-up in non-overlapping samples from the Schizophrenia Psychiatric GWAS Consortium (5537 patients, 8043 controls) provided further support for our finding (p=0.0239, odds ratio=1.07). Our data suggest that genetic variation in NCAN is a common risk factor for BD and schizophrenia. [PubMed Citation] [Order full text from Infotrieve]

19) Lester D
Spirituality and religiosity as predictors of depression and suicidal ideation: an exploratory study.
Psychol Rep. 2012 Feb;110(1):247-50.
In a sample of 149 undergraduate students, measures of religiosity and spirituality were positively associated with measures of depression, mania, and past suicidal ideation. [PubMed Citation] [Order full text from Infotrieve]

20) Khalili N, Gudarzi SS
Opioid withdrawal-induced hypomania: a case series.
J Opioid Manag. 2012 Jan-Feb;8(1):67-72.
The aim of this study was to report hypomanic symptoms after opioid withdrawal. In this case series, nine opioid-dependent patients with hypomanic profile on opioid withdrawal were selected from outpatients in a private psychiatric clinic. Opium dependency was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Substance history, clinical features, temperament, and family history were retrospectively probed. Patients displayed pure or mixed hypomanic symptoms on opioid withdrawal. In nearly all subjects, the symptoms continued until individuals started taking the opioid again. Features of hyperthymic temperament and family history of bipolarity were traced in most of the individuals. [PubMed Citation] [Order full text from Infotrieve]