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Raja, 2004

Created By: Mariela Dagio


Suicide attempts: differences between unipolar and bipolar patients and among groups with different lethality risk.


Servizio Psichiatrico di Diagnosi e Cura, Dipartimento di Salute Mentale, Ospedale Santo Spirito, Via Prisciano 26, 00136 Rome, Italy. michele.raja@fastwebnet.it



The present naturalistic study aimed to distinguish between suicide attempts (SAs) of bipolar and unipolar patients, and among SAs characterized by different lethality risk.


The records of 2395 consecutive admissions to our psychiatric intensive care unit (PICU) were assessed for presence of suicide attempt (SA). Cases of SA were rated for symptom severity with the brief psychiatric rating scale (BPRS), the scale for the assessment of positive symptoms (SAPS), the scale for the assessment of negative symptoms (SANS), the mini mental state examination (MMSE), the global assessment of functioning scale (GAF) and the clinical global impression (CGI). An original questionnaire was administered to explore clinical aspects related with suicidal behavior.


[1] Among 2395 admissions, 80 (3.3%) had attempted suicide. Fifty-three cases (66.2%) suffered from a mood episode, including 22 (27.5%) with unipolar depression and 31 (38.7%) with bipolar depression (types I and II combined) or mixed state, while 27 (33.8%) cases received other diagnoses. Forty-eight (60%) cases had attempted suicide prior to the index episode. Ten cases (12.5%) had a relative who attempted or committed suicide. Thirty-nine cases (48.7%) described their SA as impulsive. Twenty cases (25.0%) reported alcohol ingestion before SA. In comparison with women, men used more violent methods. Cases characterized by a non-lethal risk SA had higher BPRS psychotic cluster and SAPS scores than cases with either low or high lethal risk SA. Bipolar cases were over-represented in the high lethality risk group. BPRS anxiety-depressive cluster score was higher in unipolar than in bipolar cases.


The sample may not be representative of all patients with SA. The questionnaire has not been standardized for use in psychiatric populations.


The higher proportion of high lethal risk SA in bipolar cases suggests that the risk of completed suicide is higher in bipolar disorder than in unipolar depression. The risk of lethality in SA was not associated with the intensity of symptoms of anxiety and depression.

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KR, 2006

Created By: Mariela Dagio

Suicide and Bipolar disorder


Suicide, which is both a stereotypic yet highly individualized act, is a common endpoint for many patients with severe psychiatric illness. [1] The mood disorders (depression and bipolar manic-depression) are by far the most common psychiatric conditions associated with suicide. [2] At least 25% to 50% of patients with bipolar disorder also attempt suicide at least once. [3] With the exception of lithium--which is the most demonstrably effective treatment against suicide-remarkably little is known about specific contributions of mood-altering treatments to minimizing mortality rates in persons with major mood disorders in general and bipolar depression in particular. [4] Suicide is usually a manifestation of severe psychiatric distress that is often associated with a diagnosable and treatable form of depression or other mental illness. In a clinical setting, an assessment of suicidal risk must precede any attempt to treat psychiatric illness.
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Burton, 2012

Created By: Mariela Dagio


A Short History of Bipolar Disorder

The concept of bipolar disorder is surprisingly modern.

Published on June 21, 2012 by Neel Burton, M.D. in Hide and Seek

The terms used for the bipolar extremes, ‘melancholy’ (depression) and ‘mania’ both have their origins in Ancient Greek. ‘Melancholy’ derives from melas ‘black’ and chole ‘bile’, because Hippocrates thought that depression resulted from an excess of black bile. ‘Mania’ is related to menos ‘spirit, force, passion’; mainesthai ‘to rage, go mad’; and mantis ‘seer’, and ultimately derives from the Indo-European root men- ‘mind’ to which, interestingly, ‘man’ is also sometimes connected. (‘Depression’, the clinical term for melancholy, is much more recent in origin and derives from the Latin deprimere ‘press down’ or ‘sink down’.) 

[1] The idea of a relationship between melancholy and mania can be traced back to the Ancient Greeks, and particularly to Aretaeus of Cappadocia, who was a physician and philosopher in the time of Nero or Vespasian (first century AD). [12] Aretaeus described a group of patients that who ‘laugh, play, dance night and day, and sometimes go openly to the market crowned, as if victors in some contest of skill’ only to be ‘torpid, dull, and sorrowful’ at other times. [2] Although he suggested that both patterns of behaviour resulted from one and the same disorder, this idea did not gain currency until the modern era.

The modern psychiatric concept of bipolar disorder has its origins in the nineteenth century. [3] In 1854, Jules Baillarger (1809–1890) and Jean-Pierre Falret (1794–1870) independently presented descriptions of the disorder to the Académie de Médicine in Paris. [4] Baillarger called the illness folie à double forme (‘dual-form insanity’) whereas Falret called it folie circulaire (‘circular insanity’). [5] Falret observed that the disorder clustered in families, and correctly postulated that it had a strong genetic basis.

[6] In the early 1900s the eminent German psychiatrist Emil Kraepelin (1856–1926) studied the natural course of the untreated disorder and found it to be punctuated by relatively symptom-free intervals. [7] On this basis he distinguished the disorder from démence précoce (schizophrenia) and coined the term ‘manic–depressive psychosis’ to describe it. Kraepelin emphasized that, in contrast to démence précoce, manic–depressive psychosis had an episodic course and a more benign outcome.

[8] Interestingly, Kraepelin did not distinguish between people with both manic and depressive episodes and people with only depressive episodes with psychotic symptoms. [9] This distinction dates back only to the 1960s, and is largely responsible for the modern emphasis on bipolarity, and hence on mood elevation, as the defining feature of the disorder.

[10]The terms ‘manic–depressive illness’ and ‘bipolar disorder’ are comparatively recent, and date back from the 1950s and 1980s respectively. [11] The term ‘bipolar disorder’ (or ‘bipolar affective disorder’) is thought to be less stigmatizing than the older term ‘manic–depressive illness’, and so the former has largely superseded the latter. However, some psychiatrists and some people with bipolar disorder still prefer the term ‘manic–depressive illness’ because they feel that it reflects the nature of the disorder more accurately.
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Asher, 2010

Created By: Mariela Dagio

Same Genes Suspected in Both Depression and Bipolar Illness

Increased Risk May Stem From Variation in Gene On/Off Switch 

Researchers, for the first time, have pinpointed a genetic hotspot that confers risk for both bipolar disorder and depression. People with either of these mood disorders were significantly more likely to have risk versions of genes at this site than healthy controls. [1] One of the genes, which codes for part of a cell's machinery that tells genes when to turn on and off, was also found to be over-expressed in the executive hub of bipolar patients' brains, making it a prime suspect. The results add to mounting evidence that major mental disorders overlap at the molecular level. 

"People who carry the risk versions may differ in some dimension of brain development that may increase risk for mood disorders later in life," explained Francis McMahon, M.D., of the NIMH Mood and Anxiety Disorders Program, who led the study.

McMahon and an international team of investigators, supported, in part by NIMH, report on the findings of their genome-wide meta-analysis online January 17, 2010 in the journal Nature Genetics.


[2] Major mood disorders affect 20 percent of the population and are among the leading causes of disability worldwide. It's long been known that bipolar disorder and unipolar depression often run together in the same families, hinting at some shared lineage. Yet, until now, no common genes or chromosomal locations had been identified.

McMahon and colleagues analyzed data from five different genome-wide association studies (GWAS) totaling more than 13,600 people, and confirmed their results in 3 additional independent samples totaling 4,677 people.

Findings of This Study

[3] Genetic variations on Chromosome 3 were significantly associated with both mood disorders. The suspect gene, called PBRM1, codes for a protein critical for chromatin remodeling, a key process in regulating gene expression. A neighboring gene is involved in the proliferation of brain stem cells.

[4] The researchers pinpointed a "protective" version of the PBRM1 gene that is carried by 41 percent of healthy controls, but only 38 percent of people with bipolar and unipolar depression. The risk version was found in 62 percent of mood disorder cases and 59 percent of controls. The researchers also showed that PBRM1 is expressed more in the prefrontal cortex of people with bipolar disorder than in controls. 


[5] Since mood disorders likely involve altered gene expression during brain development and in response to stress, PBRM1's profile makes it a good potential candidate gene. This first genetic evidence of unipolar/bipolar overlap is also the first significant genome-wide association with any psychiatric illness in the Chromosome 3p region. 

However, the findings underscore limitations of the GWAS approach, which looks for connections to gene versions that are common in the population. Having one copy of this risk variant increases vulnerability for developing a mood disorder by a modest 15 percent. Why do some people with this variant — and presumably other, yet to be discovered, shared risk genes — develop bipolar disorder while others develop unipolar depression or remain healthy? Environmental influences and epigenetic factors may be involved, suggest the researchers, who note that "genetic association findings so far seem to account for little of the inherited risk for mood disorders."

"Our results support the growing view that there aren't common genes with large effects that confer increased risk for mood disorders," said McMahon. "If there were, in this largest sample to date, we would have found them. The disorders likely involve many genes with small effects — and different genes in different families — complicating the search. Rarer genes with large effects may also exist."

What's Next?

Ultimately, findings such as these may lead to identification of common biological pathways that may play a role in both unipolar and bipolar illness and suggest strategies for better treatment, said McMahon. The results add to other evidence of overlap that is spurring a new NIMH initiative to make sense of research findings that don't fit neatly into current diagnostic categories. See: Genes and Circuitry, Not Just Clinical Observation, to Guide Classification for Research.

Bipolar disorder and unipolar depression often run in the same families, as this pedigree diagram illustrates. The new study is the first to trace both illnesses to a shared chromosomal hotspot.
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Anonymous 5, 2013

Created By: Mariela Dagio

How does bipolar disorder affect someone over time?

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:
[1] 1.Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior.
[2] 2.Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
[3] 3.Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
[4] 4.Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.2 Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder.3 Rapid cycling affects more women than men.4

[5] Bipolar disorder tends to worsen if it is not treated. [6] Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.5 [7] Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.6

[8] Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

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Anonymous 4, 2013

Created By: Mariela Dagio

What is hypothyroidism?

[1] Hyperthyroidism means your thyroid makes too much thyroid hormone. Your thyroid is a gland in the front of your neck . It controls your metabolism, which is how your body turns food into energy. It also affects your heart, muscles, bones, and cholesterol.

[2] Having too much thyroid hormone can make a lot of things in your body speed up. You may lose weight quickly, have a fast heartbeat, sweat a lot, or feel nervous and moody. Or you may have no symptoms at all. While your doctor is doing a test for another reason, he or she may discover that you have hyperthyroidism.

Hyperthyroidism is easily treated. With treatment, you can lead a healthy life. Without treatment, hyperthyroidism can lead to serious heart problems, bone problems, and a dangerous condition called thyroid storm.

What causes hyperthyroidism?

Graves' disease causes most hyperthyroidism. In Graves? disease, the body's natural defense (immune) system attacks the thyroid gland. The thyroid fights back by making too much thyroid hormone. Like many thyroid problems, it often runs in families.

Sometimes hyperthyroidism is caused by a swollen thyroid or small growths in the thyroid called thyroid nodules.

This topic focuses on hyperthyroidism caused by Graves' disease.
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