Characterization of Bipolar Disorder I and II: Clinical Features, Comorbidities, and Pharmacological Pattern.

Objective: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides precise diagnostic criteria to differentiate between bipolar disorder (BD) type I and II; nevertheless, it can be challenging to come up with the right diagnosis. The aim of this study is to evaluate the sociodemographic differences, clinical features, comorbidities, and pharmacological pattern between patients with BD type I and II. Methods: A total of 680 patients with BD type I and II were consecutively recruited to our psychiatry department. A semi-structured interview was used to collect several information. Results: Patients with BD type I were mostly males, single, with a lower current age, and unemployed compared to patients with BD type II. Furthermore, patients with BD type I showed an earlier age at onset and a significant higher prevalence of psychotic and residual symptoms, a higher number of hospitalizations, and involuntary admissions. On the other hand, patients with BD type II were associated with a significant higher prevalence of lifetime suicide attempts, psychiatric comorbidities, and use of alcohol. Finally, antidepressant drugs were prescribed more often to patients with BD type II, while antipsychotics and mood stabilizers were mostly prescribed in patients with BD type I. Conclusion: the differentiation of the 2 nosologic bipolar diagnosis is in line with the current scientific interest, confirming the existence of a markedly different profile between BD type I and II. This differentiation could reduce the heterogeneity of bipolar presentation in research, optimize clinical assessment, and increase the interest in developing more precise and individualized therapeutic strategies, also implementing psychosocial therapies.

LGAD-Based Silicon Sensors for 4D Detectors.

Low-Gain Avalanche Diodes (LGAD) are a class of silicon sensors developed for the fast detection of Minimum Ionizing Particles (MIPs). The development was motivated by the need of resolving piled-up tracks of charged particles emerging from several vertexes originating from the same bunch-crossing in High-Energy Physics (HEP) collider experiments, which, however, are separated not only in space but also in time by a few tens of picoseconds. Built on thin silicon substrates and featuring an internal moderate gain, they provide fast signals for excellent timing performance, which are therefore useful to distinguish the different tracks. Unfortunately, this comes at the price of poor spatial resolution. To overcome this limitation, other families of LGAD-based silicon sensors which can deliver in the same substrate both excellent timing and spatial information are under development. Such devices are, to name a few, capacitively coupled LGADs (AC-LGAD), deep-junction LGADs (DJ-LGAD) and trench-isolated LGADs (TI-LGADs). These devices can be fabricated by even small-scale research-focused clean rooms for faster development within the scientific community. However, to scale up production, efforts towards integrating these sensor concepts in CMOS substrates, with the obvious advantage of the possibility of integrating part of the read-out electronics in the same substrate, have begun.

The Need for Collective Awareness of Attempted Suicide Rates in a Warming Climate.

Background: Climate factors may offer a stronger explanation of the variations in suicide rates compared with economic variables, even in the case of patients admitted involuntarily. Aims: We assessed the role of temperature as a determinant of the increased prevalence of suicide attempts (SA). Method: The sample comprised all cases of hospitalization for SA at the Psychiatric Clinic of the IRCCS Ospedale Policlinico San Martino between August 2013 and July 2018. For ambient temperature, data were provided by the Meteorological Observatory of the University of Genoa. Results: We noted a peak in suicides that was typically found in late spring and early summer due to global warming. Limitations: Other environmental/psychological factors contributing to the onset of an acute clinical event were not considered. The cross-sectional design of the study is another limitation. Conclusion: Further studies are needed to clarify the impact of climatic factors on suicide behavior and implement early intervention and preventive strategies for mental health.

Meteorological Variables and Suicidal Behavior: Air Pollution and Apparent Temperature Are Associated With High-Lethality Suicide Attempts and Male Gender.

This study analyzed the impact of meteorological variables and high-lethality suicide attempts (HLSA) to assess a potential time shift of HLSA affected by climate evolution to predict the suicide attempt cases over different periods of the year. After attempting suicide, 225 subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the psychiatric unit from March 2016 to July 2018. Socio-demographic and clinical characteristics as well as the meteorological variables were collected. The Mann-Kendall test as well as redundancy and cross-correlation analyses were performed to analyze the trends, statistically correlations, and correspondence of the trends, respectively between suicidal behaviors and climatic factors. Sixty-seven (29.8%) committed a HLSA. Our findings indicate a significant association between HLSA and male gender and apparent temperature with a strong correlation of 75% with a phase shift of -1 month. Solar radiation and air pollution (PM2.5) have a positive correlation of 65 and 32%, respectively, with a zero-time lag. Limitations include that the data are limited to a single hospital; psychological factors, or other clinical variables that could be ruled out as a trigger have not been considered. Meteorological variables may not mirror the temperature that the patient is exposed to due to the air conditioning systems. Exploring those environmental factors associated with HLSA in a more detailed manner could lead to early intervention and prevention strategies for such distressing admissions.

High-lethality of suicide attempts associated with platelet to lymphocyte ratio and mean platelet volume in psychiatric inpatient setting.

OBJECTIVES: A wide range of potential psychosocial, biological, genetic and environmental factors may interact with each other in determining suicidal behaviours. The aim of this study was to evaluate several biological parameters referred to the complete blood count values in 259 suicide attempters (SA) and 164 non-suicide attempters (control group), according to the lethality of suicidal behaviour. METHODS: After attempting suicide, subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the section of Psychiatry from 1 January 2014 to 31 June 2019. Socio-demographic and clinical characteristics, as well as blood cells, were collected. RESULTS: Individuals with high-lethality suicide attempts had a higher number of neutrophils, mean platelet volume, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and lower number of lymphocytes relative to both those with low-lethality suicide attempts and control group. After regression analysis, only the mean platelet volume and platelet to lymphocyte ratio resulted associated with a high-lethality suicide attempt (HLSA). CONCLUSIONS: Our findings provide potential and useful peripheral biological markers able to help clinicians in understanding the complex phenomenon of suicide. However, further studies are needed to confirm the present findings.

The Association Between Dyslipidemia and Lethality of Suicide Attempts: A Case-Control Study.

Evidence supports the existence of an association between dyslipidemia, psychiatric disorders, and suicide risk due to the effects of altered lipid profiles on serotoninergic neuron membranes. The aim of this study was to investigate the differences in c-reactive protein (CRP), thyroid functioning, total cholesterol, high lipoprotein density cholesterol (HDL-c), low-lipoprotein density cholesterol (LDL-c), and triglycerides (TG) serum levels in low lethality (LLSA) vs. high lethality suicide attempters (HLSA) within 24 h from the suicide attempt and inpatients who never attempted suicide (NAS). After attempting suicide, subjects were admitted to the emergency ward of the IRCCS Ospedale Policlinico San Martino and later to the section of Psychiatry from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics, serum lipids profile, CRP, and thyroid functioning were collected. The sample consisted of 133 individuals with a HLSA, 299 subjects with LLSA, and 200 patients NAS. HLSA subjects were more likely to be males and diagnosed as having a bipolar disorder. Furthermore, HLSA subgroup showed significantly lower total cholesterol and LDL-c levels and higher CRP serum levels compared to LLSA and control group, respectively. LLSA subgroup showed higher HDL-c levels compared to HLSA subgroup (no differences between HLSA and control group were observed). Additionally, the control group reported higher triglycerides levels compared to patients admitted to psychiatric ward for a suicide attempt. Only male gender, having a diagnosis of bipolar disorder, lower total cholesterol, and higher CRP serum levels predicted HLSA. Investigating the relation between dyslipidemia and the severity of suicide attempts may contribute to reveal the complex determinants underlying at-risk behaviors such as suicide, thus playing a relevant role in the possible prevention of this disabling phenomenon.

The role of seasonality and photoperiod on the lethality of suicide attempts: A case-control study.

BACKGROUND: The risk factors related to suicidal behaviors are complex and not yet fully known. Several studies underline how suicide results from the combination of psycho-social, biological, cultural, and environmental factors. The aim of this study was to investigate the potential role of seasonality and photoperiod on high-lethality suicide attempts (HLSA) compared with low-lethality suicide attempts (LLSA) in a sample of psychiatric inpatients. METHODS: After attempting suicide, subjects were admitted in the emergency/psychiatric ward of the IRCCS Ospedale Policlinico San Martino from 1st August 2013 to 31st July 2018. Socio-demographic and clinical characteristics were collected. RESULTS: The sample consisted of four hundred thirty-two individuals admitted for suicide attempt. One hundred thirty-three subjects (30.8%) of the sample committed a HLSA. The HLSA group peaked in the months with a higher sunlight exposure (June and July). Bivariate correlation analyses between seasonality/photoperiod in the whole sample and HLSA were positively associated with summer and highest solar intensity period. LIMITATIONS: Data were limited to a single hospital, patients' seasonal environment, meteorological variables and psychological factors. In addition, the presence of acute life-events fostering the suicidal crisis has not been investigated. CONCLUSIONS: The current study provides a novel perspective on the questions surrounding the impact of seasonality and daylight exposure on lethality of suicide attempts. further studies are needed to provide deeper understandings on the delicate molecular network that links suicide behaviors, seasonality and daylight in order to develop more effective prevention and treatment strategies in the future.

The personal experience of severe suicidal behaviour leads to negative attitudes towards self- and other's suicidal thoughts and behaviours: A study of temperaments, coping strategies, and attitudes towards suicide among medical students.

The attitudes individuals have towards suicidal behaviour, be it their own or others', and their capacity for developing specific coping strategies are influenced by affective temperaments that play a significant role in emotional regulation. However, few studies have investigated these specific patterns with a view to stratify them according to the severity of suicidal behaviours in medical students. The Pearson χ2 test for the comparison of categorical variables, the t-test for independent samples of continuous variables and logistic regression analysis were used to compare the association among temperaments, coping strategies, and attitudes towards suicide in a sample of medical students who attend the School of Medicine, Genoa. Severe suicidal thoughts and behaviours relative to those who were not at risk for suicide were also revealed. The severe suicidal thought and behaviour group had significantly more anxious and cyclothymic temperaments together with a higher use of dis-adaptive, lower emotional focus coping strategies, and higher self-reproaching, criticizing, and judgemental attitudes towards suicidality compared to the no severe suicidal thought and behaviour group. The identified pattern suggests the need for clinicians to carefully consider the complex interplay of clinical features which characterize severely at risk for suicide young adults in order to develop effective and comprehensive prevention strategies.