Bipolar Affective Disorder Research Articles

Associations between lifetime reproductive events among postmenopausal women with bipolar disorder.

The premenstrual phase of the menstrual cycle, childbirth and perimenopause often coincide with a worsening of mood symptoms in women with bipolar disorder (BD). To date, findings from the limited number of studies investigating associations between these events among women with BD have been inconsistent. This study aimed to investigate associations between episodes in relation to the perimenopause and (i) premenstrual symptoms and (ii) postpartum mood episodes in a large sample of postmenopausal women with BD. Among 567 postmenopausal women with BD, recruited as part of the UK Bipolar Disorder Research Network, relationships between reproductive event-associated mood symptoms/episodes were examined. Multivariate binary analyses were carried out to identify if history of premenstrual symptoms and/or postpartum episodes predicted the occurrence of mood episodes in relation to the perimenopause, controlling for potential confounders including number of mood episodes per illness year. History of premenstrual symptoms was associated with experiencing any type of mood episode, and depression specifically, during the perimenopause (OR 6.189, p < 0.001 and OR 2.709, p = 0.019 respectively). History of postpartum depression within 6 weeks of delivery was associated with depressive episodes during the perimenopause (OR 2.635, p = 0.027). Postpartum mania was not a significant predictor. Our findings suggest that women with BD with a history of premenstrual symptoms and postpartum depression are potentially at increased risk of experiencing episodes of depression in relation to the perimenopause. There are clinical and self-management implications in identifying a subgroup of women with BD who may be particularly vulnerable to episodes of mood disturbance during reproductive events.

Features of Cognitive Impairment in Bipolar Affective Disorder

Features of Cognitive Impairment in Bipolar Affective Disorder

Bipolar Affective Disorder Occurring with Psychopharmacotherapy-Induced Manic Phases

Bipolar Affective Disorder Occurring with Psychopharmacotherapy-Induced Manic Phases

Addressing treatment hurdles in adults with late-onset attention-deficit/hyperactivity disorder: a detailed case report

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is the most prevalent psychiatric disorder in children, characterized by inattention, hyperactivity, and impulsivity. This neurobehavioral disorder often persists into adulthood, presenting significant challenges when undiagnosed and untreated, due to potential long-term implications and comorbidities, including anxiety, mood instability, and mixed symptoms along the bipolar spectrum.Case presentationA 49-year-old married male patient presented with anxiety and recurrent depressive episodes, initially diagnosed as major depressive disorder. His mood symptoms fluctuated between depressive lows, irritability, and impulsivity. His diagnosis was revised to ADHD with comorbid bipolar spectrum disorder. The patient exhibited lifelong ADHD symptoms affecting academic performance, relationships, and job responsibilities. Cognitive-behavioral therapy (CBT) was employed to manage symptoms and enhance coping strategies. Despite progress in controlling anger and impulsivity, challenges persisted in inhibitory control and negative triggers, causing impulsive decisions. The patient reported a restless mind, depressive mood, and a sense of inadequacy. Improvements were noted in anxiety regulation, concentration, and sleep quality, though deficits in cognitive and behavioral domains remained. The patient faced challenges in academic performance, information processing speed, attention, and executive functions.ConclusionThis case underscores the importance of accurately diagnosing ADHD and its comorbidities in adults to ensure effective treatment. Delayed diagnosis can have lasting impacts, emphasizing the need for further research and personalized therapeutic approaches. The insights from this case serve as a valuable resource for healthcare professionals enhancing their understanding of the diverse manifestations of ADHD, aiding in better diagnosis and management strategies.

Diseases Caused by and Behaviors Associated with Toxoplasma gondii Infection

Toxoplasma gondii is an Apicomplexan parasite that is estimated to infect at least one-third of the global human population. T. gondii infection may be transmitted horizontally or vertically. The main risk factors for transmission to humans are related to diet, especially the consumption of undercooked meat, along with soil contact. In immunocompetent persons, the acute infection may go undetected as it typically produces minor, non-specific symptoms that are self-limited. After infection is established, recurrent retinochoroiditis is the most common clinical disease. In contrast, severe systemic or cerebral toxoplasmosis may be life-threatening for immunocompromised individuals. Furthermore, congenital toxoplasmosis acquired in utero may have devastating consequences if not recognized and promptly treated. A growing body of research has identified associations between latent T. gondii infection, and personality traits and risk-taking behaviors. Other studies have documented associations between latent infection and psychiatric conditions that include schizophrenia and bipolar affective disorder. With no current treatment regimens being curative of T. gondii infection, effective prevention measures at both the public health and individual levels are vitally important.

Valproate-induced hyperammonemic encephalopathy in neurosurgical patients: Our experience and systematic literature review.

Sodium valproate is used for the management of seizures, status epilepticus, chronic pain syndrome, bipolar, and other affective disorders. Even with an acceptable safety profile, severe idiosyncratic reactions can occur with valproate use. A rare, serious, and life-threatening side effect of valproate is valproate-induced hyperammonemic encephalopathy (VHE). We intend to analyze the clinical presentation, diagnosis, treatment options, and outcome of VHE in neurosurgical patients and review the pertinent literature on this rare sequelae. We retrospectively reviewed patients who developed VHE following valproate use, either for the treatment of epilepsy or for seizure prophylaxis in our centre. We analyzed the demographic details, clinical presentation, diagnosis, management, and outcomes. A total of four patients with a mean age of 26.3 ± 5.1 (range 19 - 32years). Valproate was prescribed for primary seizure prophylaxis in 2 patients (50%). The commonest etiology for valproate prescription was for brain tumors (3, 75%) followed by drug-refractory epilepsy (DRE) (1, 25%). None of the patients were documented to have urea cycle disorder. The mean daily prescribed dosage of valproate was 1250 ± 559mg and the mean duration of administration was 13 ± 13.3months (range 4months - 36months). The mean serum NH3 level was 136,5 ± 44.2µmol/L (range 107 - 212.8) and all patients (4, 100%) had hyperammonemia with a mortality rate of 50% (2 patients). The hyperammonemia was treated by stopping the valproate use (4, 100%) and dialysis (2, 50%). Normalization of ammonia levels led to clinical improvement in 50% (2 patients). Neurological deterioration in the postoperative period is a diagnostic challenge. VHE is a rare and life-threatening sequelae of Valproate-associated Hyperammonemia (VAH) in neurosurgical patients. A high index of suspicion is required due to its ambiguous presentation. Early diagnosis and prompt treatment can change the course of this life-threatening sequelae.

Temperament and creativity – implications for mental health and education

Creativity is a complex phenomenon, which level is affected by variables such as intellectual competence, temperament, personality and emotions. Research shows that patients with bipolar affective disorder have a higher level of creativity than healthy controls. The model of affective temperament developed by Hagop Akiskal enables the research on relationships between predispositions to bipolar disorder and creativity. Previous studies on the relationship between affective temperament and creativity are conducted by comparing temperaments of representatives of creative professions and people outside this group, as well as by studying the relationship between affective temperament and creativity assessed both subjectively and through objective tests. However, the temperamental traits contributing to creative potential have their downside, as they have been linked to higher risk of psychological and emotional problems. They may also be related to poorer educational and academic achievement. The article presents up to date research on the relationship between affective temperament and creativity, as well as mechanisms explaining them. It also discusses the relationship between temperament, mental health, and educational achievement, as well as its implications for psychological and pedagogical interventions.

Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS). We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs. From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%. Overall bed numbers remained static, with non-acute beds declining, and commensurate expansion of acute beds. Community GMHS had high outpatient utilisation, with high rates of schizophrenia, schizoaffective disorder, and bipolar affective disorders as primary diagnoses in mid-life. From 2017-18 to 2021-22, GMHS inpatient and ambulatory episodes had decreasing rates of significant improvement and increasing rates of significant deterioration. Although GMHS has the highest overall population and service utilisation, there has been static bed availability and relatively small increases in expenditure which are occurring concurrently with worsening clinical outcomes. Evidence-based modelling of GMHS and outcomes is required to inform future service improvement.

General health and social outcomes 50 years after exposure to antenatal betamethasone: follow-up of a randomised controlled trial

BackgroundAntenatal corticosteroids are recommended for women at risk of preterm birth from 24 to 34 weeks’ gestation as they reduce neonatal morbidity and mortality, but evidence regarding their long-term effects on offspring is limited. This study assessed general health and social outcomes 50 years after antenatal exposure to corticosteroids.MethodsWe assessed 424 adult offspring of women who participated in the first randomised, double-blind, placebo-controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. The first 717 mothers received two intramuscular injections of betamethasone (6 mg betamethasone sodium phosphate and 6 mg betamethasone acetate) or placebo given 24 h apart and the subsequent 398 received two injections of double dose betamethasone (12 mg betamethasone sodium phosphate and 12 mg betamethasone acetate) or equivalent volume of placebo. Follow-up included a health questionnaire and consent for access to administrative data sources. Outcome categories included mental health (depression, anxiety, bipolar affective disorder, schizophrenia and treatment or hospital admission for any mental health disorder), general health (chronic kidney disease, cancer diagnosis, bone fracture, oral health, allergies, functional difficulties and physical activity) and social outcomes (educational attainment, employment and criminal convictions). Investigators remained blinded to treatment allocation. Analyses were adjusted for gestational age at entry, sex and clustering.ResultsWe assessed 424 adult offspring (46% of survivors; mean [SD] age 49.3 [1.0] years; 212 [50%] female). There was no difference in mental health, general health and social outcomes between those exposed to betamethasone and those exposed to placebo, with the exception that osteoporotic site fracture in adulthood was more likely to have occurred in the betamethasone group compared with placebo (adjusted relative risk 1.57, 95% CI 1.00, 2.48, p = 0.05). No dose–effect relationship was evident and there was no difference in the proportion with at least one fracture. Follow-up rate and lack of in-person assessments were the main limitations.ConclusionsThere is no evidence that antenatal corticosteroids have clinically important effects on general health and social outcomes up to 50 years of age.

The efficacy of valproate in acute mania, bipolar depression and maintenance therapy for bipolar disorder: an overview of systematic reviews with meta-analyses.

This study aims to conduct an overview on the comparative efficacy of valproate in acute mania, bipolar depression and maintenance treatment of bipolar disorder (BD). We performed an overview of systematic reviews with meta-analyses of randomised controlled trials (RCTs), registered in PROSPERO (CRD42024497749). We searched Medline and Cochrane Database of Systematic Reviews. Summary measures comparing valproate with placebo or other active drugs were described. We included 26 systematic reviews. For acute mania (31 RCTs, n=4376), valproate showed a significantly better response than placebo in two high-quality systematic reviews (RR=1.42; 95% CI: 1.19 to 1.71) (OR=2.05; 95% CI: 1.32 to 3.20). No significant differences with lithium were found in most outcomes. Valproate had similar efficacy to quetiapine and lower efficacy compared with risperidone, with conflicting results when compared with olanzapine. In bipolar depression (7 RCTs, n=399), valproate was more effective than placebo in reducing depressive symptoms (OR=2.80; 95% CI: 1.26 to 6.18) and achieving remission (OR=2.4; 95% CI: 1.09 to 5.29) (OR=2.15; 95% CI: 0.82 to 5.6), considering the results of three high-quality systematic reviews. No significant difference was observed with lithium, lurasidone, quetiapine or olanzapine plus fluoxetine, but valproate showed superior efficacy to aripiprazole, ziprasidone and agomelatine. In maintenance treatment (11 RCTs, n=1063), valproate was superior to placebo in preventing relapse of any mood episode in two high-quality systematic reviews (RR=0.63; 95% CI: 0.48 to 0.83) (RR=0.63; 95% CI: 0.47 to 0.83). No significant difference was found with lithium, olanzapine or lamotrigine. This overview highlights favourable results for valproate compared with placebo in all phases of BD, as well as presenting specific results in comparison with other active drugs. However, these results must be interpreted considering the methodological limitations of our study.

Plasma neurofilament light outperforms glial fibrillary acidic protein in differentiating behavioural variant frontotemporal dementia from primary psychiatric disorders

ObjectiveTimely, accurate distinction between behavioural variant frontotemporal dementia (bvFTD) and primary psychiatric disorders (PPD) is a clinical challenge. Blood biomarkers such as neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) have shown promise. Prior work has shown NfL helps distinguish FTD from PPD. Few studies have assessed NfL together with GFAP. MethodsWe investigated plasma GFAP and NfL levels in participants with bvFTD, bipolar affective disorder (BPAD), major depressive disorder (MDD), treatment-resistant schizophrenia (TRS), healthy controls (HC), adjusting for age and sex. We compared ability of GFAP and NfL to distinguish bvFTD from PPD. ResultsPlasma GFAP levels were significantly (all p < 0.001) elevated in bvFTD (n = 22, mean (M) = 273 pg/mL) compared to BPAD (n = 121, M = 96 pg/mL), MDD (n = 42, M = 105 pg/mL), TRS (n = 82, M = 67.9 pg/mL), and HC (n = 120, M = 76.8 pg/mL). GFAP distinguished bvFTD from all PPD with an area under the curve (AUC) of 0.85, 95 % confidence interval [0.76, 0.95]. The optimal cut-off of 105 pg/mL was associated with 73 % specificity and 86 % sensitivity. NfL had AUC 0.95 [0.91, 0.99], 13.3 pg/mL cut-off, 88 % specificity, 86 % sensitivity, and was superior to GFAP (p = 0.02863) and combination of GFAP and NfL (p = 0.04726). ConclusionsThis study found elevated GFAP levels in bvFTD compared to a large cohort of PPD, but NfL levels exhibited better performance in this distinction. These findings extend the literature on GFAP in bvFTD and build evidence for plasma NfL as a useful biomarker to assist with distinguishing bvFTD from PPD. Utilisation of NfL may improve timely and accurate diagnosis of bvFTD.

First bipolar episode following booster dose of COVID-19 vaccination

Introduction and importance: The interactions between the susceptibility of the host and some of the COVID-19 vaccine components happened. Viral infections, including COVID-19, are related to the pathogenesis of bipolar disorder (BD). These findings could trigger an initial bipolar episode. Case presentation: A 48-year-old Syrian married female, presented to the out-clinic of Modern Medical Centre Hospital, in July 2022 for episodes of sub-maniac/mania episodes, which began within 15 days after the booster dose of COVID-19 vaccination, preceded by depressive mood. Both family and personal past psychiatric and/or trauma history were negatives. Initiation of carbamazepine 600 mg/day showed significant improvement within 3 days; 3 months later, carbamazepine dose was decreased to 200 mg/day, as there were no clinical symptoms. Clinical discussion: mRNA vaccines of COVID-19 increase the levels of type I interferon (INF), an inflammatory cytokine that creates a signal leading to the expression of interleukins, INF, and tumor necrosis factor-alpha. The pathology of BD is also unclear. Genetic predisposition, immunological effects, and the classification of BD, itself, as an autoimmune disease play a role. Although rapid improvement following treatment, prolonged and maintenance treatment by essentially mood stabilizer should be considered in bipolar episodes initiated by COVID-19 vaccination. Rare data are available about maniac episodes after COVID-19 infection, but to our knowledge, we reported the first case of bipolar onset after the booster vaccination of COVID-19. Conclusion: Bipolar disease can present following a booster dose of COVID-19 vaccination in previously healthy people.

Antipsychotics vs. Mood Stabilizers for Acute Mania in Youth

Antipsychotics vs. Mood Stabilizers for Acute Mania in Youth

Breast Cancer and Mental Health: Incidence and Influencing Factors-A Claims Data Analysis from Germany.

With breast cancer (BC) survival improving due to optimized therapy, enhancing quality of life has become increasingly important. Both diagnosis and treatment, with their potential side effects, pose risks to mental well-being. Our study aimed to analyze the incidence and potential risk factors for mental disorders in BC patients. This retrospective analysis used claims data from AOK Baden-Wuerttemberg, including 11,553 BC patients diagnosed via ICD code C50 between 2010 and 2020 and 31,944 age-matched controls. Patients with mental disorders in the 12 months prior to diagnosis were excluded. Mental disorders were categorized into eight groups based on ICD codes: anxiety, obsessive compulsive disorder, adjustment disorder, dissociative disorder, hypochondriac disorder, affective disorder, mania, and other neuroses. Mental disorders were significantly more common in BC patients than in controls (64.2% vs. 38.1%, p < 0.01, OR 2.91, 95%CI [2.79, 3.04]). In particular, hypochondriac, anxiety, affective, and adjustment disorders occurred significantly more often in BC patients. No differences were found for mania, bipolar disease, other neuroses, obsessive compulsive-, or dissociative disorders. Furthermore, endocrine therapy was associated with psychological comorbidities (OR 1.69, p < 0.001, 95%CI [1.53, 1.86]), while primarily metastasized patients (stage C) had a lower risk than adjuvant patients in stage A (OR 0.55, p < 0.0001, 95%CI [0.49, 0.61]). Regarding surgical treatment, mastectomy patients showed lower rates of mental illnesses (61.2%) than those with breast-conserving treatment (71.6%), or especially breast reconstruction (78.4%, p < 0.01). Breast reconstruction was also associated with more hypochondriac (p < 0.01) and adjustment disorders (p < 0.01). So, BC patients experience significantly more mental disorders than controls, particularly when treated with endocrine therapy and breast reconstructive surgery.

Mendelian randomisation analysis to explore the association between cathepsins and bipolar disorder

IntroductionBipolar disorder is a psychiatric condition characterized by the coexistence of depression and mania. Diagnosis of this disorder can be challenging due to limited pathologic and experimental tools. Treatment compliance is often poor due to medication side effects. Although cathepsin is known to play a significant role in diseases such as tumors and osteoporosis, its role in psychiatric disorders is not yet fully understood.ObjectiveThe aim of this study was to investigate the relationship between cathepsin in the blood circulation and bipolar disorder.MethodsThe causal relationship between cathepsin and different subtypes of bipolar affective disorder was explored using bidirectional Mendelian randomization analysis and multivariate analysis.ResultsIt was found that cathepsin H level was a protective factor for type II bipolar disorder. No potential causal relationship was found between cathepsin H and type I bipolar disorder, but cathepsin B changes with the development of type I bipolar disorder. A causal relationship was found between cathepsin H and cerebral dopamine neurotrophic factor.ConclusionsIn conclusion, cathepsin H may be a diagnostic target for bipolar II disorder and may play a guiding role in clinical diagnosis. Cathepsin H may have an effect on BD through cerebral dopamine neurotrophic factor.

Complications after cardiac implantable electronic devices in patients with severe mental illness: a Danish nationwide study

Abstract Background Patients with mental illness experience higher rates of postoperative complications and mortality across several types of surgery, but knowledge is lacking in relation to cardiac implantable electronic device (CIED) implantations. Purpose Our study aimed to investigate the 7-day, 30-day, and 90-day postoperative complication rate and mortality in patients with severe mental illness compared to the general population. Methods All adult patients in Denmark with a first-time pacemaker or ICD implantation during the study period from July 1995 to December 2022 were identified using the Danish nationwide registers. Severe mental illness was defined as having a preexisting diagnosis of schizophrenia and other non-affective psychotic disorders, bipolar affective disorders or major depressive disorder. Postoperative complications were obtained as diagnosis codes possibly relating to device implantation and categorized into seven types of complications: arterial thrombosis, venous thrombosis, pneumothorax, bleeding, infection, device function problem, and death. Stratified logistic regression analyses adjusted for sex and age were used to calculate the odds of postoperative complications within 7, 30, and 90 days of device implantation. Results Among 108,790 patients who had a de novo pacemaker or ICD implantation the mean age was 73.5 (± 12.8), 37.5% were women and 3,393 (3.1%) of the patients had preexisting severe mental illness. In total, 10,690 (9.8%) patients had one or more complications within 90 days. The number of patients with severe mental illness who experienced a complication were 407 (12.0%) while it was 10,283 (9.8%) of those without severe mental illness. Odds of death (OR 1.57, 95% CI: 1.03-2.29) were higher in patients with severe mental illness 7 days postoperatively, and 30 days postoperatively odds of venous thromboembolism (OR: 1.69, 95% CI: 1.05-2.56) and death (OR: 1.62, 95% CI: 1.29-2.01) were higher in patients with severe mental illness. 90 days postoperatively odds of venous thrombosis (OR: 1.95, 95% CI: 1.37-2.70), infection (OR: 1.45, 95% CI: 1.16-1.79), and death (OR: 1.40, 95% CI: 1.19-1.65) were higher in patients with severe mental illness compared to patients without severe mental illness, while the odds of pneumothorax were lower at all three time points for patients with severe mental illness (OR 7-days: 0.49, 95% CI: 0.21-0.95). The odds of arterial thrombosis, bleeding and device function problems were similar between the two groups at all three time points. Conclusion Severe mental illness was associated with increased risk of several types of complications and death following CIED implantation. This indicates that further care and attention is needed to ensure adequate treatment of patients with severe mental illness suffering from cardiac arrhythmias.Forest plot, SMI: severe mental illness

Drug utilization study of antidepressant drugs in psychiatric outdoor patients at a tertiary care hospital in Southern Rajasthan

Background: The World Health Organization (WHO) defines “Drug Utilization” as the marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social, and economic consequences. Antidepressants are used to treat depressive illnesses and anxiety disorders. However, these are also employed in the pharmacotherapy of several psychiatric disorders. Very few studies were found regarding the pattern of prescription of antidepressants in outdoor patients in southern Rajasthan. So, this study has been planned to learn about the prescription pattern of antidepressant drugs as per WHO Core Drugs Prescribing indicators at a tertiary care hospital in southern Rajasthan. Methods: A cross-sectional observational study was conducted among 375 patients by convenient sampling over one year duration, in the outdoor Department of Psychiatry at RNT Medical College, Udaipur, Rajasthan. Patient’s prescriptions were analyzed for drug utilisation pattern in OPD after relevant consent. All data was compiled in MS Excel and analyzed using statistical methods. Results: Out of 375 prescriptions analyzed, 48.8% were males and 51.2% were females. Most commonly, patients had a diagnosis of depressive disorder (42.93%), followed by bipolar affective disorder (14.4%). The most common drug class prescribed was SSRI (88.86%). Escitalopram (41.65%) was the most prescribed drug, followed by Sertraline (30.51%). Conclusions: Among the prescribed antidepressants SSRIs were the most common class of drug followed by TCA. Escitalopram was the most common drug to be prescribed followed by sertraline. More than half of the patients receiving antidepressants suffered from non-depressive disorders. Monotherapy was preferred over combination therapy. All patients were prescribed generic drugs.

Organic mental illnesses are outlawed: farewell to Karl Bonhoeffer

The article analyzes the reasons for the deletion of the section “Organic mental disorders” from the psychiatric classifications (ICD-11, DSM-5) and its replacement by the sections “Neurocognitive disorders” and “Secondary mental and behavioral disorders associated with disorders and diseases classified in other chapters”. It is argued that at the present stage of development of psychiatry it has become clear that not only organic mental disorders are associated with impaired brain function, but also all others, e.g. the disorders of the schizophrenic spectrum. This leads to the conclusion that the term “organic” has become an anachronism and no longer reflects the essence of psychogenesis. As a result, changes in terminology in modern psychiatric classifications should be recognized as justified. However, the term “organic disorders” did not have a stigmatizing character, unlike, for example, “psychopathy”, “oligophrenia”, “hysteria” or “manic-depressive psychosis”. It undoubtedly had an indeterminate character, as it interpreted pathological changes in the brain broadly and was opposed to the concept of “functional disorders”. At the current stage of development of psychoneurology, organic causes are often found behind the functional. Exclusion of the term “organic” from the psychiatric lexicon, rejection of the Bonhoeffer approach, the Walter-Buell triad and the psychoorganic syndrome can be considered superfluous, since the introduction of the concept of “secondary mental disorders” in their place does not alter the process of understanding the nature of psychogenesis. It is concluded that the division of mental disorders into so-called primary and secondary disorders is no better than the opposition of functional and organic disorders, and that the “outdated” approach can be used in the training of young psychiatrists, emphasizing that the term “organic” can also be extended to mental disorders that used to be called endogenous.

Ten Years of Bipolar Telehealth: Program Evaluation of a Team-Based Telemental Health Clinic.

Objectives: Telemental health via videoconferencing (TMH-V) can overcome many of the barriers to accessing quality mental health care. Toward this end, in 2011, the U.S. Department of Veterans Affairs (VA) established the National Bipolar Disorders TeleHealth (BDTH) Program to provide expert mental health consultation and treatment to Veterans with bipolar spectrum disorders. Methods: Initial analyses of BDTH services suggested that participants had positive changes in quality-of-care indices and clinical outcomes; however, that evaluation was based on a limited sample of both participants and VA medical centers. We were able to confirm and expand upon those early results by using nearly eight times the number of participants and more than twice as many medical centers. Results: For the 2,456 Veterans who completed the intake to our program, there were significant improvements in some of the quality metrics (e.g., lithium use) and a 54% reduction in positive suicide screens (p < 0.05). The Veterans who completed the initial and postprogram assessments (n = 815) reported a 16.6% reduction in manic symptoms (p < 0.001), a 29.3% reduction in depressive symptoms (p < 0.001), and a 21.2% reduction in mood episodes (p < 0.001). Additionally, these Veterans demonstrated significant improvements (p < 0.001) in mental health-related quality of life between the two assessments. Conclusions: These analyses provide further support for the general effectiveness and safety of telemental health via videoconferencing. Future research should examine the generalizability of these findings across various subgroups (e.g., minority patients, patients in rural areas), populations, and health care systems.

Individuals Who Had a Lifetime History of Suicide Attempts and Their Relationships With Inflammation, Severity of Depressive Symptoms, and Childhood Maltreatments

Abstract Lifetime history of suicide attempts is associated with inflammatory mechanisms, severity of depressive symptoms, and childhood trauma. This cross-sectional study enrolled 54 suicide attempters and 154 nonsuicide attempters. All individuals were assessed through a questionnaire, a structured clinical interview, scales, anthropometric measures, and laboratory biomarkers. Individuals with a history of lifetime suicide attempts showed significant positive correlations regarding soluble tumor necrosis factor receptor 1 and severity of depressive symptoms (p = 0.013), interleukin-1 receptor antagonist and severity of depressive symptoms (p = 0.04), and absenteeism from work and childhood physical abuse (p = 0.012). Suicide attempters also experienced more childhood trauma (sexual abuse, physical abuse, emotional abuse, emotional neglect, and physical neglect) compared with nonsuicide attempters. IL-4 levels were significantly lower in individuals who attempted suicide than in nonsuicidal individuals. Lifetime suicide attempts in major affective disorders were associated with childhood trauma and proinflammatory and anti-inflammatory cytokines.