Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed

Biological pathways associated with neuroprogression in bipolar disorder

There is evidence suggesting clinical progression in a subset of patients with bipolar disorder (BD). This progression is associated with worse clinical outcomes and biological changes. Molecular pathways and biological markers of clinical progression have been identified and may explain the progressive changes associated with this disorder. The biological basis for clinical progression in BD is called neuroprogression. We propose that the following intertwined pathways provide the biological basis of neuroprogression: inflammation, oxidative stress, impaired calcium signaling, endoplasmic reticulum and mitochondrial dysfunction, and impaired neuroplasticity and cellular resilience. The nonlinear interaction of these pathways may worsen clinical outcomes, cognition, and functioning. Understanding neuroprogression in BD is crucial for identifying novel therapeutic targets, preventing illness progression, and ultimately promoting better outcomes

Mild depression levels alter self-perceptions of future but not the recall of verbal information in elderly inpatients

In order to determine the correlation of levels of symptoms of depression and rate of forgetting and perception of the future, a total of 68 elderly inpatients without Major Depression admitted to a general hospital were evaluated by: 1) the Montgomery-Asberg Depression Rating Scale (MADRS), 2) the Mini-Mental State Examination (MMSE), 3) a questionnaire on future self-perceptions (FSPQ), and 4) a test on the recall of verbal information to estimate the rate of forgetting. They were grouped according to the clinical prognosis of their disease (good, N = 48, 25 women, 23 men, age mean ± SD, 68 ± 6.64; poor, N = 20, 10 women, 10 men, age mean± SD, 69 ± 6.68) which correlates with morbidity-mortality rates (low/high). There was no relationship between mild levels of signs and symptoms of depression and increased forgetting. However, levels of depression were negatively correlated to the score of future perceptions (B = -0.18, beta = -0.29, P = 0.032). Patients with diseases with good prognosis did not present different levels of depression, rates of forgetting or future expectations from those of patients with poor prognosis (high mortality rates). However, individuals with negative FSPQ scores showed significantly higher MADRS scores, independent of the type of disease. These data suggest that the modifications in the processing of information related to the future are present in clinical patients without Major Depression but they occur within a small range of very mild signs and symptoms of depression

Dosagem da proteína S100B em sangue de pacientes com transtorno do estresse pós-traumático e comparação com controles normais

41

Transtorno do estresse pós-traumático : comorbidades e tratamento

14

Consensus on nomenclature for clinical staging models in bipolar disorder : a narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Objectives: Clinical staging is widely used in medicine to map disease progression, inform prognosis, and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking. Methods: Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders. Results: Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthreshold stages, and to various clinical stages of BD as it is currently diagnosed. Conclusion: The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light