Showing papers on "Mood disorders published in 1997"

Structured clinical interview for DSM-IV axis I disorders : SCID-I : clinical version : scoresheet

Abstract: This efficient, user-friendly instrument will help clinicians make standardized, reliable, and accurate diagnoses and avoid the common problem of "premature closure" -- the premature focus on one diagnostic possibility. It will also help clinicians of all levels of experience improve their clinical assessment and interviewing techniques and provides extensive documentation of the diagnostic process, an essential procedure in today's managed care world. Specifically adapted from the research standard for Axis I structured clinical interviewing for use in clinical settings, the SCID-I covers those DSM-IV diagnoses most commonly seen by clinicians and includes the diagnostic criteria for these disorders with corresponding interview questions. The SCID-I is divided into six self-contained modules that can be administered in sequence: mood episodes; psychotic symptoms; psychotic disorders; mood disorders; substance use disorders; and anxiety, adjustment, and other disorders. The Scoresheet, available in sets of five, is a one-time-use scoresheet used to record diagnostic decisions. It also contains abridged DSM-IV diagnostic criteria. This is a package of 5.

Subgenual prefrontal cortex abnormalities in mood disorders

Abstract: Pathological disturbances of mood may follow a 'bipolar' course, in which normal moods alternate with both depression and mania, or a 'unipolar' course, in which only depression occurs. Both bipolar and unipolar disorders can be heritable illnesses associated with neurochemical, neuroendocrine and autonomic abnormalities. The neurobiological basis for these abnormalities has not been established. Using positron emission tomographic (PET) images of cerebral blood flow and rate of glucose metabolism to measure brain activity, we have now localized an area of abnormally decreased activity in the prefrontal cortex ventral to the genu of the corpus callosum in both familial bipolar depressives and familial unipolar depressives. This decrement in activity was at least partly explained by a corresponding reduction in cortical volume, as magnetic resonance imaging (MRI) demonstrated reductions in the mean grey matter volume in the same area of 39 and 48% in the bipolar and unipolar samples, respectively. This region has previously been implicated in the mediation of emotional and autonomic responses to socially significant or provocative stimuli, and in the modulation of the neurotransmitter systems targeted by antidepressant drugs.

Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey.

Abstract: Background. Survey data are presented on the associations between retrospectively reported childhood adversities and subsequent onset and persistence of DSM-III-R disorders. Methods. Data come from the US National Comorbidity Survey, a large survey of the US household population. Results. Twenty-six adversities were considered, including loss events (e.g. parental divorce), parental psychopathologies (e.g. maternal depression), interpersonal traumas (e.g. rape) and other adversities (e.g. natural disaster). These adversities were consistently associated with onset, but not persistence, of DSM-III-R mood disorders, anxiety disorders, addictive disorders and acting out disorders. Most bivariate associations with onset attenuated in models that controlled for clustering of adversities and for lifetime co-morbidities among psychiatric disorders. Multivariate effects of adversities in logistic models were additive, which means that they have multiplicative effects on probability of disorder onset. Adversities showed little specificity. An analysis of time decay showed that the effects of childhood adversities on disorder onset persist beyond childhood. Conclusions. The existence of strong clustering among childhood adversities and lifetime co-morbidity among adult disorders means that caution is needed in interpreting the results of previous single-adversity single-disorder studies as documenting unique effects of specific childhood adversities on specific adult disorders. Future studies need to assess a broader range of adversities and disorders and to explore the existence and effects of commonly occurring adversity clusters. Replication is needed to verify that the effects of childhood adversities are mostly on first onset rather than on the creation of vulnerabilities that lead to increased risk of persistence.

Behavioral observations at age 3 years predict adult psychiatric disorders: longitudinal evidence from a birth cohort

Abstract: Background: This study provides, to our knowledge, the first empirical test of whether behavioral differences among children in the first 3 years of life are linked to specific adult psychiatric disorders: anxiety and mood disorders, antisocial personality disorder, recidivistic and violent crime, alcoholism, and suicidal behavior. Methods: In a longitudinal-epidemiological study, 3-year-old children were classified into groups based on examiner observations of their behavior. At age 21 years, they were reassessed for psychopathologic functioning using standardized interviews based on DSM-IIJ-R criteria. Results: Although effect sizes were small,undercontrolled(includes children who are impulsive, restless, and distractible) andinhibited(includes children who are shy, fearful, and easily upset) children differed significantly from comparison children in young adulthood. Undercontrolled 3-year-olds were more likely at 21 years to meet diagnostic criteria for antisocial personality disorder and to be involved in crime. Inhibited 3-year-olds were more likely at 21 years to meet diagnostic criteria for depression. Both groups were more likely to attempt suicide, and boys in both groups had alcohol-related problems. Controls for family social class did not change the findings. Conclusions: Some forms of adult psychopathologic abnormality are meaningfully linked, albeit weakly, to behavioral differences observed among children in the third year of life.

The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents.

Abstract: Background: We estimated the 6-month prevalence of psychiatric disorders among Dutch adolescents, using standardized, internationally available, and replicable assessment procedures, and assessed sex differences and comorbidity of diagnoses. Methods: In phase 1, the parent, self-report, and teacher versions of the Child Behavior Checklist screened a sample representative of 13- to 18-year-olds from the Dutch general population. In phase 2, the parent (P) and child (C) versions of the Diagnostic Interview Schedule for Children (DISC) provided DSM-III-R diagnoses for a selected subsample of 780 subjects. Results: The prevalence of any disorder was 21.5% for the DISC-C and 21.8% for the DISC-P. There was little overlap between subjects identified as having a disorder by the DISC-P and the DISC-C; only 4% met the criteria for any disorder on both. The most common disorders were simple phobia, social phobia, and conduct disorder. The most frequent comorbid diagnoses were anxiety and mood disorders. Conclusions: Although prevalences of more than 21% for DISC-C—and DISC-P—derived diagnoses seem high, many adolescents with DSM-III-R diagnoses functioned quite well. The prevalence of any DSMIII-R diagnosis based on the DISC-C or DISC-P, in combination with the criterion for a definite case, was 7.9%.

Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort.

Abstract: Objective: The purpose of the study was to examine the quantitative risk of criminal behavior associated with specific mental disorders. Method: An unselected 1966 birth cohort (N=12,058) in Northern Finland was prospectively studied until the end of 1992. The investigation started during the mothers’ pregnancy, and the data on the subjects’ family characteristics, mental and physical development, living habits, psychiatric morbidity, and criminal records were gathered at various times. Results: The prevalence of offenses was the highest among males with alcohol-induced psychoses and male schizophrenic subjects with coexisting alcohol abuse, and more than half of the schizophrenic offenders also had problems with alcohol. Eleven (7%) of the 165 subjects who committed violent crimes were diagnosed as psychotic. Male schizophrenic subjects had a moderately high risk for violent offenses, but the risk for other types of crimes was not elevated significantly. Odds ratios for criminal behavior were adjusted according to the socioeconomic status of the childhood family and were the same as or slightly lower than the crude odds ratios for all disorders except schizophrenia and mood disorders with psychotic features. Conclusions: The results indicate that the risk of criminal behavior was significantly higher among subjects with psychotic disorders, even though the socioeconomic status of the childhood family was controlled. The higher risk for violent behavior was associated especially with alcohol-induced psychoses and with schizophrenia with coexisting substance abuse. The results suggest that schizophrenia without substance abuse may also be associated with a higher risk of offenses, but this finding is tentative and requires further investigation. (Am J Psychiatry 1997; 154:840‐845)

Comparison of induced and independent major depressive disorders in 2,945 alcoholics.

Abstract: Objective: Depressive episodes among alcohol-dependent men and women are heterogeneous in causation and clinical course. This study tested three hypotheses regarding the rates and clinical characteristics of two potential subtypes of these affective states: those that appear to be substance-induced mood disorders and those that are independent major depressive episodes. Method: Semistructured, detailed interviews were administered to 2,945 alcohol-dependent subjects as part of the Collaborative Study on the Genetics of Alcoholism. With the use of a time line method for determining the type of mood disorder among probands, relatives, and comparison subjects, individuals with histories of the two types of mood disorders were compared. Results: Major depressive episodes with an onset before the development of alcohol dependence or during a subsequent long abstinence period (i.e., independent depressions) were observed in 15.2% of the alcoholics, while 26.4% reported at least one substance-induced depressive episode. According to a logistic regression analysis, the subjects with independent (as compared to substance-induced) major depressive episodes were more likely to be married, Caucasian, and female, to have had experience with fewer drugs and less treatment for alcoholism, to have attempted suicide, and, on the basis of personal interviews with family members, to have a close relative with a major mood disorder. Conclusions: These results support the contention that it is possible to differentiate between what appear to be substance-induced and independent depressive episodes in alcoholics. Such differentiation might be important for establishing prognosis and optimal treatment. (Am J Psychiatry 1997; 154:948‐957)

Violent behavior during sleep.

Abstract: Background Although the relative incidence of violent behavior during sleep (VBS) is presumed to be low, no epidemiologic data exist to evaluate the prevalence of the phenomenon or to begin to understand its precursors or subtypes This study examined the frequency of violent or injurious behavior during sleep and associated psychiatric risk factors Method A representative United Kingdom sample of 2078 men and 2894 women between the ages of 15 to 100 years (representing 796% of those contacted) participated in a telephone interview directed by the Sleep-EVAL expert system specially designed for conducting such diagnostic telephone surveys Results Two percent (N = 106) of respondents reported currently experiencing VBS The VBS group experienced more night terrors and daytime sleepiness than the non-VBS group Sleep talking, bruxism, and hypnic jerks were more frequent within the VBS than the other group, as were hypnagogic hallucinations (especially the experience of being attacked), the incidence of smoking, and caffeine and bedtime alcohol intake The VBS group also reported current features of anxiety and mood disorders significantly more frequently and reported being hospitalized more often during the previous 12 months than the non-VBS group Subjects with mood or anxiety disorders that co-occurred with other nocturnal symptoms had a higher risk of reporting VBS than all other subjects Conclusion We have identified a number of sleep, mental disorder, and other general health factors that characterize those experiencing episodes of VBS These findings suggest that specific factors, perhaps reflecting an interaction of lifestyle and hereditary contributions, may be responsible for the observed variability in this rare but potentially serious condition

Cognitive impairment in the euthymic phase of chronic unipolar depression.

Abstract: Cognitive functioning in the nonsymptomatic phase and the long-term cognitive outcome of patients with mood disorders are both heuristic and important clinical issues in the study of mood disorders. Literature findings are inconsistent because of design confounds. We tried to address these issues while controlling for several confounds including age, education, gender differences in neurobehavioral functioning, and diagnosis. Nonsymptomatic patients with a history of chronic unipolar depression and bipolar affective disorder and healthy male individuals were administered neuropsychological tests to assess attention, visual-motor tracking, executive abilities, and immediate verbal memory. Subjects had comparable depression scores at the time of testing. Disease duration was 7.5 years (SD 5.1) for unipolar and 11 years (SD 7.3) for bipolar patients. Unipolar patients were more impaired than healthy normal comparison subjects on measures of visual-motor sequencing (Trail Making Test A, p < .05), executive function (Trail Making Test B, Stroop Test Color/Word Trial, p < .05), and immediate memory and attention (CERAD 1st trial, WAIS Digit Symbol subtest, p < .05). Differences between bipolar patients and normal comparison subjects did not reach significance in any of the selected measures. Male patients with a history of chronic unipolar disorder are at risk for cognitive impairment in the nonsymptomatic phase of their disease. Cognitive disturbance is the type seen with prefrontal dysfunction and may be assessed with standard neuropsychological assessments.

Associations between different diagnostic approaches for child and adolescent psychopathology.

Abstract: Objective: To test the convergence between the empirical-quantitative approach of the Child Behavior Checklist (CBCL) and the clinical-diagnostic approach of the DSM. Method: The parent version of the NIMH Diagnostic Interview Schedule for Children (DISC), version 2.3, was administered after completion of the CBCL for 231 children and adolescents consecutively referred to an outpatient mental health clinic. Results: Of the subjects with a DSM-III-R diagnosis, 60% scored in the clinical range of the CBCL total problem score. The Withdrawn scale predicted affective and anxiety disorders. The Somatic Complaints scale predicted anxiety and mood disorders and Attention Deficit Hyperactivity Disorder. The Anxious/Depressed scale predicted anxiety and mood disorders and, to a lesser extent, disruptive behavior disorders. The Social Problems scale predicted Oppositional Defiant Disorder. The Attention Problems scale was the only significant predictor of “pure” Attention Deficit Hyperactivity Disorder (ADHD). The Aggressive Behavior scale predicted several disruptive behavior disorders, and Major Depression. The Delinquent Behavior scale was strongly associated with Conduct Disorder. Conclusions: Empirically based CBCL scale scores and DISC-P based DSM-III-R diagnoses converged. However, both approaches do not converge to a degree that one approach can replace the other. Instead, combining both approaches may be valuable by adding information from one approach that is not captured by the other.

Impaired neuropsychological performance in euthymic patients with recurring mood disorders

Abstract: Background: Both patients suffering from schizophrenia and patients suffering from recurring mood disorder show cognitive impairments as established by a variety of neuropsychological tests. The aim of the present study was to investigate the neuropsychological performance of euthymic patients who had recurring mood disorder and the possible relationship between episodes of hospitalization and cognitive impairments. Method: Twenty-six euthymic patients with a DSM-III-R recurring mood disorder diagnosis were investigated by using the Synonym Reasoning and Block-Test Battery and a part of the Halstead-Reitan Test Battery. Results: An overall lowered performance in the test results was found. There was a significant positive relationship between four different tests and the number of hospitalization episodes; the patients with impaired cognitive functioning had significantly more hospitalization episodes than patients with normal cognitive functioning. Conclusion: The results suggest that a subgroup of patients with recurring mood disorder are defined by more relapses and episodes of hospitalization and show cognitive dysfunctions even when euthymic.

Recovery From Major Depression: A 10-Year Prospective Follow-up Across Multiple Episodes

Abstract: Background: Major depressive disorder is often marked by repeated episodes of depression. We describe recovery from major depession across multiple mood episodes in patients with unipolar major depression at intake and examine the association of sociodemographic and clinical variables with duration of illness. Methods: A cohort of 258 subjects treated for unipolar major depressive disorder was followed up prospectively for 10 years as part of the Collaborative Depression Study, a multicenter naturalistic study of the mood disorders. Diagnoses were made according to the Research Diagnostic Criteria, and the course of illness was assessed with the Longitudinal Interval Follow-up Evaluation. Survival analyses were used to calculate the duration of illness for the first 5 recurrent mood episodes after recovery from the index episode. Results: Diagnosis remained unipolar major depressive disorder for 235 subjects (91%). The median duration of illness was 22 weeks for the first recurrent mood episode, 20 weeks for the second, 21 weeks for the third, and 19 weeks for the fourth and fifth recurrent mood episodes; the 95% confidence intervals were highly consistent. From one episode to the next, the proportion of subjects who recovered by any one time point was similar. For subjects with 2 or more recoveries, the consistency of duration of illness from one recovery to the next was low to moderate. None of the sociodemographic or clinical variables consistently predicted duration of illness. Conclusion: In this sample of patients treated at tertiary care centers for major depressive disorder, the duration of recurrent mood episodes was relatively uniform and averaged approximately 20 weeks.

Expressed Emotion Toward Children With Behavioral Inhibition: Associations With Maternal Anxiety Disorder

Abstract: Objective To examine the role of maternal psychopathology in influencing "expressed emotion" (EE) directed toward children with behavioral inhibition (BI) or psychiatric disorders. Method Maternal EE was assessed via Five-Minute-Speech-Sample in two samples of children previously evaluated for child and maternal lifetime prevalence of DSM-lll disorders and assessed via laboratory observations for Bl. The authors previously reported that maternal EE was associated with Bl and with the number of child behavior and mood disorders in these samples. The at-risk sample ( N = 30) consisted of mothers with panic disorder and psychiatric controls and their 4− through 10-year-old children. The Kagan sample ( N = 41) consisted of children selected at age 21 months as Bl or uninhibited and followed through age 11. Results Interaction effects were found: In mothers with anxiety disorders, but not those without, maternal criticism (a component of EE) was significantly associated with child Bl, independently of the child's number of disorders. Similarly, in mothers with anxiety disorders only, maternal criticism was significantly associated with a high number of child disorders. Conclusions The relationships between mothers who have anxiety disorders and their children who have Bl or psychiatric disorders may be marked by criticism or dissatisfaction. If confirmed, these findings offer opportunities for appropriate interventions. J. Am. Acad. Child Adolesc. Psychiatry. 1997, 36(7):910–917.

The life‐time rates of three major mood disorders and four major anxiety disorders in alcoholics and controls

Abstract: Aims. While psychiatric symptoms are common in the general population and even more prevalent in alcoholics, their clinical implications are not clear. The goal of this study was to establish the life-time rates of several independent and concurrent mood and anxiety disorders in alcoholics, controls and their relatives. Design. Structured interviews were administered to alcoholics entering treatment, their relatives, and controls. Setting. The study was carried out in six different centers in the United States as pan of the Collaborative Study on the Genetics of Alcoholism (COGA). Participants. Data were gathered from 2713 alcohol dependent subjects (probands and their alcoholic relatives) and 919 controls. Measurements. The timeline-based Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) interview teas administered face to face by trained, closely supervised interviewers. The life-time rates for concurrent and independent disorders were determined for three DSM-HI-R major mood and four major anxiety disorders. Findings. Some form of independent mood disorder was seen during the life-time in slightly fewer alcoholics than controls (14.0% and 17.1%), but alcoholics did show higher rates of independent bipolar disorder (2.3% vs. 1.0%). The life-time rate for independent anxiety disorders was significantly higher in alcoholics than controls (9.4% vs. 3.7%), with most of the differential related to panic disorder (4.2% vs. 1.0%) and social phobia (3.2% vs. 1.4%), but no significant group differences for agoraphobia or obsessive-compulsive disorder. In general, these findings regarding mood and anxiety disorders were reflected in close relatives. Conclusions. The large majority of alcohol-dependent men and women in this sample did not have any of the independent mood or anxiety disorders evaluated here. However, there was evidence of enhanced risks among alcoholics for independent bipolar panic and social phobic disorders. Studies which do not distinguish carefully between independent and concurrent mood and anxiety disorders in alcoholics are likely to report much higher rates of co-morbid psychiatric disorders than those that distinguish between the two types of syndromes.

Rapid depletion of plasma tryptophan: a review of studies and experimental methodology.

Abstract: Evidence that the neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) plays a role in the pathophysiology of mood disorders has been accumulating over the past three decades. Recent studies on this neurotransmitter have extended across the spectrum of psychiatric disorder, suggesting a role for 5-HT in psychosis, aggression, eating disorders and addiction. However, much of the evidence has come from post-mortem examination of the brain or measures of peripheral rather than central 5-HT function. The technique of tryptophan depletion allows investigation of brain 5-HT function in living subjects by examining the behavioural responses to this pharmacological challenge. This review considers the current status of tryptophan depletion as an experimental technique and discusses the implications of findings both in affective disorders and in a range of other psychiatric syndromes. MEDLINE and PSYCHLIT searches were completed for the years 1966 to November 1996 using the key words 'serotonin', '5-hydroxytryptamine', 'tryptophan' and 'depletion'. In addition relevant journals were hand-searched for the period from 1980 to December 1996. Forty-four double-blind studies in humans and three clinical case reports were identified; these cover a range of psychiatric disorders including mood disorders and psychoses, anxiety and eating disorders and specific behaviours such as appetite, aggression and craving. The studies reviewed utilized a variety of differing methodologies reducing the extent to which results can be generalized. A series of studies in depressed patients (before and after treatment with antidepressants) and their first-degree relatives have shown the importance of an intact 5-HT system in the action of antidepressants and offer new insights into the biology of affective disorder. The mood change induced by tryptophan depletion may predict those patients likely to respond to 5-HT-specific drugs. Rapid tryptophan depletion has also been reported to exacerbate both panic and aggression in vulnerable individuals. Effects in other disorders are conflicting and further research is needed to clarify these findings.

A review of functional neuroimaging in mood disorders: positron emission tomography and depression.

Abstract: Objective:To examine the progress of positron emission tomography (PET) as a tool for understanding the psychobiology of mood disorders, particularly major depression and bipolar disorder.Method:Re...

The New York High-Risk Project: Prevalence and Comorbidity of Axis I Disorders in Offspring of Schizophrenic Parents at 25-Year Follow-up

Abstract: Background: The New York High-Risk Project is a study of offspring of patients with schizophrenia (HRSz group) or affective illness (HRAff group) and psychiatrically normal parents (NC group) observed prospectively from childhood to adulthood. We herein present lifetime prevalence and comorbidity rates of Axis 1 disorders in subjects and their siblings from sample A of the project. Methods: Schedule for Affective Disorders and Schizophrenia—Lifetime Version interviews conducted with the offspring in adulthood were used to obtain diagnoses of Axis I disorders. Results: Schizophrenia and unspecified psychoses occurred only in the HRSz group. However, schizoaffective and psychotic affective disorders occurred equally in the HRSz and HRAff groups. Total rates of psychosis in these groups were significantly higher than in the NC group. All groups had similar rates of nonpsychotic affective and substance abuse disorders. The HRAff group, however, had significantly more total affective illness than the NC group and tended to have more anxiety disorders than the other groups. Comorbidity rates in the HRSz and HRAff groups were nearly twice those of the NC group. Conclusions: The familial liabilities to schizophrenia and affective disorders show specificities and commonalities, differing markedly from each other in their expression of some disorders and sharing others. Patterns of comorbidity are generally, although not entirely, similar to these liabilities.

Depression in Adults with Diabetes.

Abstract: Diabetes doubles the likelihood of comorbid depression, which impairs functioning and quality of life. This mood disorder has a unique importance in diabetes because of its associations with treatment noncompliance, insulin resistance, hyperglycemia and an increased risk for diabetes complications.

Use of the Beck Anxiety and Depression Inventories for Primary Care with Medical Outpatients.

Abstract: The effectiveness of the Beck Anxiety (BAI-PC) and Depression (BDI-PC) Inventories for Primary Care for discriminating 56 primary care patients with and without revised, third edition Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) diagnosed anxiety and mood disorders was studied. The Anxiety and Mood modules from the Primary Care Evaluation of Mental Disorders (PRIME-MD) were used to establish diagnoses. The coefficient alphas for the BAI-PC and BDI-PC were, respectively, .90 and .88. A BAI-PC cutoff score of 5 and above yielded the highest clinical efficiency (82%) with 85% sensitivity and 81% specificity for identifying patients with and without panic, generalized anxiety, or both disorders, whereas a BDI-PC cutoff score of 6 and above afforded the highest clinical efficiency (92%) with 83% sensitivity and 95% specificity for detecting patients with and without major depressive disorders. The use of these instruments to screen primary care patients before conducting extensive diagnostic evaluations with them was discussed.

Eating disorders and comorbidity: empirical, conceptual, and clinical implications.

Abstract: The most common major comorbid disorders associated with eating disorders include substance use disorders, personality disorders, mood disorders, anxiety disorders, and obesity. To test conceptual models of the relationship between the eating disorders and these comorbid disorders, complex research paradigms are needed, including epidemiological studies, behavior-genetic studies, and longitudinal research designs. Comorbidity may be a significant factor to consider as approaches to the treatment of eating disorders continue to evolve.

Abecarnil for the treatment of generalized anxiety disorder: a placebo-controlled comparison of two dosage ranges of abecarnil and buspirone.

Abstract: Premenstrual dysphoric disorder (PMDD) is a premenstrual mood disorder that cyclically recurs during the majority of menstrual cycles. It is included under the category of "depressive disorders not otherwise specified" in DSM-IV. Given the placement of PMDD with other mood disorders in DSM-IV, the evidence suggesting an association between PMDD and other mood disorders is examined. Primary reports on the epidemiology, phenomenology, family history, psychobiology, and treatment of PMDD were examined for features that are commonly found in other mood disorders. There is an overlap in the symptoms experienced by women with PMDD and patients with other mood disorders. As in patients with other mood disorders, past episodes of mood disorder and family history of mood disorder are common in women with PMDD. Selected biological markers differentiate women with PMDD from controls, and some but not all antidepressants are effective in the treatment of PMDD. Many features of PMDD support its inclusion in the DSM-IV category of mood disorders. However, a number of factors (biological and cognitive studies, treatment response) differentiate PMDD from other mood disorders.

Effect of lithium maintenance on suicidal behavior in major mood disorders.

Abstract: We reviewed evidence of a possible antisuicide action of lithium maintenance treatment in mood disorders. Of 28 published studies involving over 17,000 patients with major affective illnesses, most yielded supportive evidence: risk of suicides and attempts averaged 3.2 versus 0.37 per 100 patient-years without versus with lithium (8.6-fold difference). In a new study of 284 bipolar I- and II-disordered patients, corresponding rates (2.2 vs. 0.39/100 patient-years) differed by 5.6-fold (p < 0.001); moreover, after discontinuing lithium, rates of suicidal acts rose by 7-fold (16-fold within the first year), and fatalities increased by nearly 9-fold. Lithium maintenance treatment in recurring major mood disorders has strong evidence of antisuicide effects not demonstrated with any other mood stabilizer. Close association of suicide and depression in bipolar disorder emphasizes the need for improved identification and treatment of bipolar depression.