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.

Association between nonalcoholic fatty liver disease and coronary artery disease / Associação entre doença hepática gordurosa não-alcoólica e doença arterial coronariana

OBJECTIVE: Although some investigations have shown a relationship between nonalcoholic fatty liver disease (NAFLD) and cardiovascular diseases, there are few studies analyzing the relationship between NAFLD and coronary artery disease (CAD). The aim of this article was to review the relationship between NAFLD and CAD and the methods of diagnosis used to assess such relationship. METHODS: A review was performed using search engines of indexed scientific material, including MEDLINE (by PubMed), Web of Science, IBECS, and LILACS, to identify articles published in Portuguese, English, and Spanish until August, 2012. The studies were eligible if they included the following data: place and year of publication, prevalence and methods used to diagnose NAFLD (ultrasound, computed tomography, nuclear magnetic resonance, or biopsy) and CAD (coronary angiography, or computed tomography), and the exclusion of patients due to alcohol consumption greater than 20 g/day. RESULTS: Ten articles were selected, most of which were cross-sectional studies. The studies mostly observed the association between NAFLD and the presence and severity of CAD. CONCLUSION: The analysis of the review showed that evaluating the existence of NAFLD in patients with CAD from its subclinical form up to the symptomatic clinical form is important due to the higher risk of acute myocardial infarction and consequent increase of mortality.

OBJETIVO: Embora algumas investigações demonstrem uma associação entre a doença hepática gordurosa não-alcoólica (DHGNA) e doenças cardiovasculares, existem poucos estudos analisando a relação entre DHGNA e doença arterial coronariana (DAC). O objetivo deste artigo foi realizar uma revisão sobre a associação entre DHGNA e CAD e os métodos diagnósticos usados para avaliar esta associação. MÉTODOS: Foi realizada uma revisão da literatura utilizando métodos de busca de material científico indexado, incluindo MEDLINE (através do PubMed), Web of Science, IBECS e LILACS, para identificar artigos publicados em português, inglês e espanhol até agosto de 2012. Os estudos eram elegíveis se incluíam os seguintes dados: local e ano de publicação, prevalência e os métodos utilizados para o diagnóstico da DHGNA (ultrassonografia, tomografia computadorizada, ressonância nuclear magnética ou biópsia) e DAC (angiografia coronária ou tomografia computadorizada),e a exclusão de pacientes com consumo de álcool maior do que 20 g/dia. RESULTADOS: Dez artigos foram selecionados, predominando os estudos de corte transversal. Na maioria dos estudos foi observada a associação entre DHGNAeapresença e gravidade da DAC. CONCLUSÃO: A análise da revisão mostra que é importante avaliar a existência de DHGNA em pacientes com DAC desde sua forma subclínica até a forma clínica sintomática, devido ao maior risco de infarto agudo do miocárdio e consequente aumento da mortalidade.