Ten-year course of treated bipolar I disorder: The role of polarity at onset

Introduction: Early-stage predictors of illness course are needed in bipolar disorder (BD). Differences among patients with a first depressive versus maniac/hypomanic episode have been stated, although in most studies, memory bias and time from onset to start of specialized treatment might interfere. The aim was to compare the first 10 years of illness course according to polarity at onset. Methods: 49 type I BD patients admitted for treatment for a first-time affective episode and a following 10-year attendance to the institution were included. A retrospective year by year comparison according to polarity at onset (depressive (DPO) or maniac (MPO)) was performed. Cramer's V and Cohen d were computed to determine effect size. Results: 59.2% (n = 29) started with MPO. Both groups were similar in demographic and social outcome characteristics, clinical features, and treatment variables. Patients with DPO reported more depressive episodes than MPO patients (U = 149.0 p < .001, Cohen's d = 0.87); both groups had a similar number of manic episodes. Only during the first year of follow-up, suicide attempts (SA) were more frequent in patients with DPO while the presence of a psychotic episode and psychiatric hospitalizations were more frequent in the MPO group. Conclusion: According to these findings, it can be concluded that illness onset is only indicative of depressive predominant polarity but is not related to other poor prognostic variables after the first year of illness onset, in treated BD. SA in the first year of an affective disorder could represent a marker of BD

No association between the HTR1A gene and suicidal behavior: a meta-analysis A não associação entre o gene HTR1A e comportamento suicida: uma metanálise

OBJECTIVE: Dysfunction of serotonin 1A receptors (HTR1A) may play a role in the genesis of suicidal behavior. We studied the association between a functional polymorphism in the HTR1A gene and suicidal behavior. METHOD: We performed a meta-analysis of published genetic association studies by searching through Medline, PubMed, and Web of Science databases to analyze a possible correlation between the rs6295 polymorphism and suicidal behavior in different populations. RESULTS: Four studies comprising a total of nine hundred and fifty seven patients with suicidal behavior and nine hundred and fifty seven controls were the eligible. The G allele of the rs6295 polymorphism may not be associated with suicidal behavior (Random-effects model: OR = 1.08; 95% CI: 0.80-1.45; p(Z) = 0.80) in presence of heterogeneity (Q = 17.84, df = 4, p = 0.0013). In a second analysis that presented no heterogeneity, a negative association was also observed (OR = 0.94; 95%CI: 0.79-1.13; p(Z) = 0.99). CONCLUSION: To our knowledge, the present study is the first meta-analysis searching for a correlation between rs6295 of HTR1A and suicidal behavior. Our results showed no association between HTR1A and suicidal behavior. However, more studies assessing different populations, as well as larger samples, are needed.OBJETIVO: É possível que uma disfunção nos receptores 1A de serotonina (HTR1A) desempenhe um papel na origem do comportamento suicida. Estudamos a associação entre um polimorfismo funcional no gene HTR1A e comportamento suicida. MÉTODO: Realizamos uma metanálise de estudos de associação genética já publicados através de uma busca nos banco de dados do Medline, PubMed e Web of Science para identificar uma possível correlação entre o polimorfismo rs6295 e comportamento suicida em diferentes populações. RESULTADOS: Foram selecionados quatro estudos com um total de 957 pacientes com comportamento suicida e 957 controles. O alelo G do polimorfismo rs6295 não pôde ser associado a comportamento suicida (modelo de efeitos aleatórios: OR = 1,08; 95%CI: 0,80-1,45; p(Z) = 0,80) na presença de heterogeneidade (Q = 17,84, df = 4, p = 0,0013). Em uma segunda análise, sem heterogeneidade, também foi observada uma associação negativa (OR = 0,94; 95%CI: 0,79-1,13; p(Z) = 0,99). CONCLUSÃO: Pelo que nos consta, trata-se da primeira metanálise cujo objetivo é identificar uma correlação entre o polimorfismo rs6295 do HTR1A e comportamento suicida. Os nossos resultados não demonstraram existir uma correlação entre o HTR1A e comportamento suicida. No entanto, são necessários estudos adicionais que incluam outras populações, assim como amostras maiores