Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach

Objectives: Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. Methods: The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. Results: The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Conclusions: Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

Bipolar disorders: is there an influence of seasonality or photoperiod?

Objective: To increase understanding of the influence of photoperiod variation in patients with bipolar disorders. Methods: We followed a sample of Italian bipolar patients over a period of 24 months, focusing on inpatients. All patients admitted to the Psychiatric Inpatient Unit of San Luigi Gonzaga Hospital in Orbassano (Turin, Italy) between September 1, 2013 and August 31, 2015 were recruited. Sociodemographic and clinical data were collected. Results: Seven hundred and thirty patients were included. The admission rate for bipolar patients was significantly higher during May, June and July, when there was maximum sunlight exposure, although no seasonal pattern was found. Patients with (hypo)manic episodes were admitted more frequently during the spring and during longer photoperiods than those with major depressive episodes. Conclusions: Photoperiod is a key element in bipolar disorder, not only as an environmental factor but also as an important clinical parameter that should be considered during treatment.

Utilidad del empleo de antidepresivos en pacientes con depresión bipolar: [revisión] / Usefulness of antidepressants in patients with bipolar disorder: [review]

Introducción: El empleo de antidepresivos para el tratamiento de los pacientes con trastorno bipolar es discutido. A pesar de la falta de claridad respecto del papel de estos agentes, su administración en la práctica clínica es frecuente, ya sea como monoterapia o en combinación con estabilizadores del estado de ánimo. Hace tres años llevamos a cabo una revisión sobre este tema. Sin embargo, desde ese momento se publicó información adicional de importancia. Objetivo: Efectuar una actualización sobre el empleo de antidepresivos en pacientes con trastorno bipolar mediante la evaluación de toda la información relevante publicada luego de nuestra primera revisión. En el presente artículo analizamos todos los estudios aleatorizados y controlados o abiertos publicados desde agosto de 2007 hasta abril de 2010 donde se evaluó: 1) la eficacia de los antidepresivos en caso de depresión bipolar aguda, 2) el riesgo de viraje maníaco durante el tratamiento antidepresivo y 3) la interrupción de los antidepresivos una vez alcanzada la respuesta al tratamiento agudo. Resultados y discusión: Los hallazgos principales del presente artículo pueden resumirse de la siguiente manera. En primer lugar, algunos antidepresivos pueden ser beneficiosos para el tratamiento agudo de los pacientes con depresión bipolar, especialmente al ser combinados con estabilizadores del estado de ánimo. En segundo lugar, los antidepresivos se asocian con índices elevados de viraje maníaco solo en algunos casos: 1) cuando no se prescriben estabilizadores del estado de ánimo en forma concomitante, 2) cuando se emplean antidepresivos tricíclicos en lugar de antidepresivos de segunda generación y 3) en presencia de síntomas hipomaníacos, aunque sean leves.