Suicide attempt, impulsivity, and exposure to trauma in college students

Objectives: Past suicide attempt (SA) is one of the most important risk factors for suicide death. An ideation-to-action framework posits that impulsivity, potentially traumatic events, and mental disorders also play a role in increasing suicide risk. This study aimed to assess the association between trait impulsivity, lifetime exposure to trauma, and post-traumatic stress disorder (PTSD) with SA in a sample of Brazilian college students. Methods: A total of 2,137 participants filled self-reported questionnaires consisting of a sociodemographic and clinical questionnaire, Trauma History Questionnaire, Post-Traumatic Stress Disorder Checklist - Civilian version, and Barratt Impulsiveness Scale. Results: Our findings suggest that trait impulsivity may be interpreted as exerting a distal effect on SA, even in the presence of other variables - such as trauma history, psychological neglect, and PTSD - which also increase the odds of SA. High and medium levels of impulsivity, history of trauma, and PTSD increased the likelihood of SA. Conclusions: Intervention strategies to prevent SA may target trait impulsivity and exposure to traumatic experiences.

Burnout syndrome and resilience in medical students from a Brazilian public college in Salvador, Brazil

Abstract Introduction Burnout syndrome is highly prevalent among medical students. Whereas burnout syndrome has been associated with negative outcomes, like suicidal ideation, protective factors are still unknown. Objective To evaluate if there is an association between burnout syndrome and resilience in medical students, assessing covariates such as depressive symptoms, suicidal ideation, and religiosity. Method This cross-sectional study was carried out with a sample of 209 students from a medical school in Brazil. Burnout syndrome was assessed using the Maslach Burnout Inventory - Student Survey. Potential protective factors and aggravators to burnout syndrome were investigated using appropriate scales. Results Fifty-nine students (28.2%) presented burnout. Multivariate analysis showed that resilience was a protective factor (p < 0.001), along with being older, married or having better academic performance. Depressive symptoms were positively associated with burnout. Religiosity was not a protective factor and suicidal ideation was not associated with burnout when adjusted for depressive symptoms. Conclusion Burnout is frequent among medical students, impacting mental health and academic performance. Resilience seems to be a protective factor, and the relationship between burnout and suicidal ideation is possibly mediated by depressive symptoms. Prospective studies are needed to further investigate the associations found in this study.

Prefrontal gray matter volume in adults bipolar I outpatients is associated with history of suicide attempts?

ABSTRACT Background: Patients with Bipolar Disorder (BD) have the highest lifetime risk for suicidal behavior (SB) compared to other psychiatric disorders. Neuroimaging research provides evidence of some structural and functional abnormalities in the brain of BD suicide attempters (SA), but interpretation of these findings may represent a number of features. Objective: The purpose of this study was to evaluate the volume of the prefrontal cortex in euthymic BD type I outpatients, with and without history of SA. Methods: 36 euthymic BD I outpatients (18 with and 18 without suicide attempt history) were underwent structural MRI and total and regional gray matter volumes were assessed and compared with 22 healthy controls (HC). Results: We did not found any differences in all areas between suicidal and non-suicidal BD I patients and BD patients as a group compared to HC as well. Discussion: our findings suggest that can be a different subgroups of patients in relation to prefrontal cortex volumes according to some clinical and socio-demographic caractheristics, such as number of previous episodes and continuous use of medical psychotropic drugs that may induce neuroplasticity phenomena, which restore cerebral volume and possibly can lead to long-term euthymia state.

Self-injurious behavior and related mortality in children under 10 years of age: a retrospective health record study in Brazil

Objective: To describe and analyze data on self-injurious behavior (SIB) and related mortality in children under 10 years old in Brazil. Methods: A descriptive study was performed using secondary public health care data extracted from the Hospital Information System (Sistema de Informações Hospitalares, SIH) and Mortality Information System (Sistema de Informações sobre Mortalidade, SIM) in Brazil. The databases are available for online access at http://datasus.saude.gov.br/. Results: In Brazil, according to SIH data, 11,312 hospitalizations of patients under 10 years of age were recorded from 1998 to 2018 as resulting from SIB (ICD-10 X60-X84 codes). Of these, 65 resulted in death. According to the SIM, from 1996 to 2016, 91 deaths related to SIB were recorded, 81 (89%) in children aged 5 to 9 years, nine (9.9%) in children aged 1 to 4 years, and one (1.1%) in a child below 1 year of age. Conclusion: These results highlight the relevance of creating measures to better understand SIB and related mortality in this age group. They also reveal the vulnerability of children in Brazil and warrant further studies to address these issues.

Suicídio e Espiritualidade / Suicide and spirituality

A religiosidade/espiritualidade (R/E) é um tema de grande interesse na atualidade, principalmente no que concerne à sua relação com a saúde mental. De fato, o efeito benéfico dessa associação tem sido descrito com níveis de bem-estar maiores, redução do uso de drogas, menores taxas de depressão e ansiedade, além de se apresentar como um fator protetor ao comportamento suicida (CS). Contudo, os mecanismos que possam explicar esses resultados ainda não foram adequadamente esclarecidos. Da mesma forma, existem muitas dificuldades em transpor esse conhecimento para a prática clínica, sendo este um dos maiores desafios deste campo de pesquisa. Assim, diante da relevância deste tópico, este artigo objetiva fazer uma atualização sobre as conexões entre R/E e CS, visando discutir não só os aspectos positivos, mas também os possíveis elementos negativos envolvidos nessa relação. Para tal, foi realizada uma revisão da literatura com ênfase em artigos publicados nas últimas duas décadas.

The relation between religiosity/spirituality (R/S) and health is a topic of great interest actually, especially regarding mental health. In fact, the beneficial effect of this association has been described with higher levels of well-being, reduction of drug use, lower rates of depression and anxiety, as well as being a protective factor specifically for suicidal behavior (SB). However the mechanisms that may explain these results have not yet been adequately clarified. Likewise, there are still many difficulties in transposing this knowledge into clinical practice, which is the biggest challenge related to this theme. Thus, in view of the relevance of the theme, this article aims to bring an update on the relation between R/S and SB, with an approach not only to the positive aspects, but also about the negative elements involved among them. To this end, we conducted a literature review with emphasis on articles published in the past two decades.

Suicide attempts in bipolar I patients: impact of comorbid personality disorders

Objective: To evaluate the association between personality disorders (PDs) and suicide attempts (SAs) in euthymic patients with type I bipolar disorder (BD). Methods: One-hundred twenty patients with type I BD, with and without history of SA, were evaluated during euthymia. The assessment included a clinical and sociodemographic questionnaire, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was employed to determine associations between history of SA and patient characteristics. Results: History of SA was significantly associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Only cluster B PDs, high attentional impulsivity, and lack of paid occupation remained significant after multivariate analysis. Conclusions: Cluster B PDs were significantly associated with SA in patients with type I BD. High attentional impulsivity and lack of gainful employment were also associated with SA, which suggests that some cluster B clinical and social characteristics may exacerbate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

Objective: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD.

Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder

Objectives: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms. Methods: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ). Results: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8±68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6±23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia. Conclusions: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Social support and bipolar disorder

Bipolar disorder is a chronic condition that affects the functioning of its carriers in many different ways, even when treated properly. Therefore, it’s also important to identify the psychosocial aspects that could contribute to an improvement of this population’s quality of life. Objective: Carry out a literature review on the role of social support in cases of bipolar disorder. Method: A research on the following online databases PubMed, Lilacs and SciELO was conducted by using the keywords “social support” or “social networks” and “mood disorders” or “bipolar disorder” or “affective disorder,” with no defined timeline. Results: Only 13 studies concerning the topic of social support and BD were found in the search for related articles. Generally speaking, the results show low rates of social support for BD patients. Discussion: Despite the growing interest in the overall functioning of patients with bipolar disorder, studies on social support are still rare. Besides, the existing studies on the subject use different methodologies, making it difficult to establish data comparisons...

Personality disorders in euthymic bipolar patients: a systematic review

Objective: To identify, by means of a systematic review, the frequency with which comorbid personality disorders (PDs) have been assessed in studies of euthymic bipolar patients. Methods: PubMed, ciELO and PsychINFO databases were searched for eligible articles published between 1997 and 2013. After screening 1,249 empirical papers, two independent reviewers identified three articles evaluating the frequency of PDs in patients with bipolar disorders assessed in a state of euthymia. Results: The total sample comprised 376 euthymic bipolar patients, of whom 155 (41.2%) had at least one comorbid PD. Among them, we found 87 (23.1%) in cluster B, 55 (14.6%) in cluster C, and 25 (6.6%) in cluster A. The frequencies of PD subtypes were: borderline, 38 (10.1%); histrionic, 29 (7.7%); obsessive-compulsive, 28 (7.4%); dependent, 19 (5%); narcissistic, 17 (4.5%); schizoid, schizotypal, and avoidant, 11 patients each (2.95%); paranoid, five (1.3%); and antisocial, three (0.79%). Conclusion: The frequency of comorbid PD was high across the spectrum of euthymic bipolar patients. In this population, the most common PDs were those in cluster B, and the most frequent PD subtype was borderline, followed by histrionic and obsessive-compulsive. .

The impacts of cognitive-behavioral therapy on the treatment of phobic disorders measured by functional neuroimaging techniques: a systematic review

Objective: Functional neuroimaging techniques represent fundamental tools in the context of translational research integrating neurobiology, psychopathology, neuropsychology, and therapeutics. In addition, cognitive-behavioral therapy (CBT) has proven its efficacy in the treatment of anxiety disorders and may be useful in phobias. The literature has shown that feelings and behaviors are mediated by specific brain circuits, and changes in patterns of interaction should be associated with cerebral alterations. Based on these concepts, a systematic review was conducted aiming to evaluate the impact of CBT on phobic disorders measured by functional neuroimaging techniques. Methods: A systematic review of the literature was conducted including studies published between January 1980 and April 2012. Studies written in English, Spanish or Portuguese evaluating changes in the pattern of functional neuroimaging before and after CBT in patients with phobic disorders were included. Results: The initial search strategy retrieved 45 studies. Six of these studies met all inclusion criteria. Significant deactivations in the amygdala, insula, thalamus and hippocampus, as well as activation of the medial orbitofrontal cortex, were observed after CBT in phobic patients when compared with controls. Conclusion: In spite of their technical limitations, neuroimaging techniques provide neurobiological support for the efficacy of CBT in the treatment of phobic disorders. Further studies are needed to confirm this conclusion. .

Comportamento suicida no transtorno afetivo bipolar e características sociodemográficas, clínicas e neuroanatômicas associadas / Suicidal behavior in bipolar affective disorder and socio-demographic, clinical and neuroanatomical characteristics associated

CONTEXTO: Pacientes com transtorno bipolar possuem risco maior de suicídio, quando comparados com a população geral e com outros transtornos psiquiátricos. Este artigo tem como objetivo revisar os aspectos sociodemográficos, clínicos e neuroanatômicos associados ao comportamento suicida em pacientes com transtorno bipolar com história de tentativa de suicídio. MÉTODOS: Revisão não sistemática da literatura, por meio dos indexadores eletrônicos: PsycoInfo, Lilacs,Medline e PubMed, utilizando-se as palavras-chave: "attempt suicide", "suicidal behavior", "suicide", "bipolar disorder", "suicide risk factor", "neuroimaging" e "suicide neurobiology". RESULTADOS: Diversas características sociodemográficas e clínicas têm sido associadas às tentativas de suicídio em pacientes bipolares, porém os resultados são ainda conflitantes. Em relação aos achados de neuroimagem, os dados também são escassos e inconsistentes. Destes, a hiperintensidade periventricular em substância branca e as alterações na estrutura e função do córtex pré-frontal são os mais descritos. CONCLUSÕES: Considerando que o suicídio é uma causa potencialmente evitável de morte, a compreensão dos correlatos clínicos e neurobiológicos do comportamento suicida pode ser útil na prevenção desse comportamento. Sendo assim, estudos que avaliem melhor os fatores de risco para o comportamento suicida nessa população são necessários.

BACKGROUND: Bipolar patients have a higher risk of suicide when compared with the general population and other psychiatric disorders. The aim of this article is to review the social-demographic, clinical and neuroanatomical aspects of suicidal behavior in bipolar patients. METHODS A non-systematic review of literature through PsycoInfo, Lilacs, Medline and PubMed eletronic databases was conducted, using the keywords: "suicide attempt", "suicidal behavior", "suicide" "bipolar disorder", "suicide risk factor," "neuroimaging", and "suicide neurobiology." RESULTS: Several clinical and sociodemographics characteristics have been associated with suicide attempts in bipolar patients, but results are conflicting. Regarding to neuroimaging, the data are rare, and the results are inconsistent, with reports of white matter hyperintensities and changes in structure and function of the prefrontal cortex. DISCUSSION: Given that suicide is a potentially preventable cause of death, the understanding of neurobiological and clinical correlates of suicidal behavior can be useful in reducing rates of attempt suicide in bipolar patients.

Prevalence and clinical impact of eating disorders in bipolar patients / Prevalência e impacto clínico dos transtornos alimentares sobre os pacientes bipolares

OBJECTIVES: To study the impact of eating disorders (EDs) on the severity of bipolar disorder (BD). METHODS: The Structured Clinical Interview for DSM-IV Axis I (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were used. Clinical and sociodemographic data were also collected. RESULTS: Among the 356 bipolar patients included in this study, 19 (5.3 percent) were also diagnosed with ED. Of these, 57.9 percent had bulimia nervosa (BN) and 42.1 percent had anorexia nervosa (AN). Among ED patients, 94.7 percent were female. Bipolar patients with EDs presented with lower scores in the mental health domain of the WHOQOL-BREF, higher scores of depressive symptoms, and more psychiatric comorbidities. CONCLUSIONS: ED comorbidities imposed important negative outcomes in bipolar patients. This finding suggests that attention should be given to the presence of EDs in BD patients and that better treatments focused on this population should be developed.

OBJETIVO: Estudar a influência dos transtornos alimentares (TA) na gravidade do transtorno bipolar (TB). MÉTODOS: Foram utilizadas a Entrevista Clínica Estruturada para o Eixo I do DSM-IV (SCID-I), a Escala de Young para Avaliação da Mania (YMRS), a Escala de Hamilton para Avaliação da Depressão (HAM-D-17), a Escala de Hamilton para Avaliação da Ansiedade (HAM-A), a Avaliação do Funcionamento Global (GAF) e a Escala Breve de Avaliação da Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-BREF). Os dados clínicos e sociodemográficos também foram coletados. RESULTADOS: Entre os 355 pacientes com TB incluídos neste estudo, 19 (5,3 por cento) também foram diagnosticados como portadores de TA. Destes, 57,9 por cento tinham bulimia nervosa (BN) e 42,1 por cento anorexia nervosa (AN). Dentre os pacientes com TA, 94,7 por cento eram do gênero feminino. Os pacientes portadores de TB e TA apresentaram escores mais baixos do domínio saúde mental da WHOQOL-BREF, escores mais elevados de sintomas depressivos e mais comorbidades psiquiátricas. CONCLUSÕES: A presença de comorbidades com TA acarreta importantes desfechos negativos em pacientes bipolares. Este achado sugere que atenção deva ser dada à presença de TA em pacientes com TB e que melhores tratamentos focados nessa população sejam desenvolvidos.

Transtornos de humor e de ansiedade comórbidos em vítimas de violência com transtorno do estresse pós-traumático / Comorbid mood and anxiety disorders in victims of violence with posttraumatic stress disorder

OBJETIVO: Buscar estudos que avaliem a comorbidade entre transtorno de estresse pós-traumático e transtornos do humor, bem como entre transtorno de estresse pós-traumático e outros transtornos de ansiedade. MÉTODO: Revisamos a base de dados do Medline em busca de estudos publicados em inglês até abril de 2009, com as seguintes palavras-chave: "transtorno de estresse pós-traumático", "TEPT", "transtorno de humor", "transtorno depressivo maior", "depressão maior", "transtorno bipolar", "distimia", "transtorno de ansiedade", "transtorno de ansiedade generalizada", agorafobia", "transtorno obsessivo-compulsivo", "transtorno de pânico", "fobia social" e "comorbidade". RESULTADOS: Depressão maior é uma das condições comórbidas mais frequentes em indivíduos com transtorno de estresse pós-traumático, mas eles também apresentam transtorno bipolar e outros transtornos ansiosos. Essas comorbidades impõem um prejuízo clínico adicional e comprometem a qualidade de vida desses indivíduos. Comportamento suicida em pacientes com transtorno de estresse pós-traumático, com ou sem depressão maior comórbida, é também uma questão relevante, e sintomas depressivos mediam a gravidade da dor em sujeitos com transtorno de estresse pós-traumático e dor crônica. CONCLUSÃO: Os estudos disponíveis sugerem que pacientes com transtorno de estresse pós-traumático têm um risco maior de desenvolver transtornos afetivos e, por outro lado, transtornos afetivos pré-existentes aumentam a propensão ao transtorno de estresse pós-traumático após eventos traumáticos. Além disso, vulnerabilidades genéticas em comum podem ajudar a explicar esse padrão de comorbidades. No entanto, diante dos poucos estudos encontrados, mais trabalhos são necessários para avaliar adequadamente essas comorbidades e suas implicações clínicas e terapêuticas.

OBJECTIVE: To review studies that have evaluated the comorbidity between posttraumatic stress disorder and mood disorders, as well as between posttraumatic stress disorder and other anxiety disorders. METHOD: We searched Medline for studies, published in English through April, 2009, using the following keywords: "posttraumatic stress disorder", "PTSD", "mood disorder", "major depressive disorder", "major depression", "bipolar disorder", "dysthymia", "anxiety disorder", "generalized anxiety disorder", "agoraphobia", "obsessive-compulsive disorder", "panic disorder", "social phobia", and "comorbidity". RESULTS: Major depression is one of the most frequent comorbid conditions in posttraumatic stress disorder individuals, but individuals with posttraumatic stress disorder are also more likely to present with bipolar disorder, other anxiety disorders and suicidal behaviors. These comorbid conditions are associated with greater clinical severity, functional impairment, and impaired quality of life in already compromised individuals with posttraumatic stress disorder. Depression symptoms also mediate the association between posttraumatic stress disorder and severity of pain among patients with chronic pain. CONCLUSION: Available studies suggest that individuals with posttraumatic stress disorder are at increased risk of developing affective disorders compared with trauma-exposed individuals who do not develop posttraumatic stress disorder. Conversely, pre-existing affective disorders increase a person's vulnerability to the posttraumatic stress disorder--inducing effects of traumatic events. Also, common genetic vulnerabilities can help to explain these comorbidity patterns. However, because the studies addressing this issue are few in number, heterogeneous and based on a limited sample, more studies are needed in order to adequately evaluate these comorbidities, as well as their clinical and therapeutic implications.