Internet and Psychiatry

Oquendo MA, Galfalvy HC, Currier D, Grunebaum MF, Sher L, Sullivan GM, Burke AK, Harkavy-Friedman J, Sublette ME, Parsey RV, Mann JJ.
Am J Psychiatry 2011 Oct;168(10):1050-6.

OBJECTIVE: Bipolar disorder is associated with high risk for suicidal acts. Observational studies suggest a protective effect of lithium against suicidal behavior. However, testing this effect in randomized clinical trials is logistically and ethically challenging. The authors tested the hypothesis that lithium offers bipolar patients with a history of suicide attempt greater protection against suicidal behavior compared to valproate. METHOD: Patients with bipolar disorder and past suicide attempts (N=98) were randomly assigned to treatment with lithium or valproate, plus adjunctive medications as indicated, in a double-blind 2.5-year trial. An intent-to-treat analysis was performed using the log-rank test for survival data. Two models were fitted: time to suicide attempt and time to suicide event (attempt or hospitalization or change in medication in response to suicide plans).

Pompili M, Rihmer Z, Akiskal H, Amore M, Gonda X, Innamorati M, Lester D, Perugi G, Serafini G, Telesforo L, Tatarelli R, Girardi P.
Compr Psychiatry. 2011 Jun 3. [Epub ahead of print]

BACKGROUND:
Several studies have demonstrated that bipolar II (BD-II) disorder represents a quite common, distinct form of major mood disorders that should be separated from bipolar I (BD-I) disorder. The aims of this cross-sectional study were to assess temperament and clinical differences between patients with BD-I and BD-II disorders and to assess whether temperament traits are good predictors of hopelessness in patients with bipolar disorder, a variable highly associated with suicidal behavior and ideation.

Strakowski SM, Adler CM, Cerullo MA, Eliassen JC, Lamy M, Fleck DE, Lee JH, Delbello MP.
Division of Bipolar Disorders Research, Department of Psychiatry, and the Center for Imaging Research, University of Cincinnati, Cincinnati, OH, USA
Early Interv Psychiatry. 2008 Nov;2(4):225-233.

OBJECTIVES: Impulsivity is common in bipolar disorder, especially during mania. Understanding the functional neuroanatomy of response inhibition, one component of impulsivity, might clarify the neural substrate of bipolar disorder.
METHODS: Sixteen DSM-IV first-episode, manic bipolar patients and 16 matched healthy subjects were examined during a first manic episode using fMRI while performing a response inhibition task. All subjects were studied using a 4 T Varian INOVA whole body MRI system. The response inhibition task was presented using nonferromagnetic goggles and task performance was recorded during scan acquisition. Imaging data were analyzed using AFNI.

Sher L, Carballo JJ, Grunebaum MF, Burke AK, Zalsman G, Huang YY, Mann JJ, Oquendo MA.
Division of Neuroscience, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
Bipolar Disord. 2006 Oct;8(5 Pt 2):543-50.

OBJECTIVES: Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.