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Kamali M, Saunders EF, Prossin AR, et al. Association between suicide attempts and elevated bedtime salivary cortisol levels in bipolar disorder. J Affect Dis. 138: 350-358

The University of Michigan, Department of Psychiatry and Depression Center, Ann Arbor, MI 48109-2700, USA.
Journal of Affective Disorders (Impact Factor: 3.71). 12/2011; 136(3):350-8. DOI: 10.1016/j.jad.2011.11.027
Source: PubMed

ABSTRACT Hypothalamic-pituitary-adrenal (HPA) axis abnormalities have been reported in bipolar disorder and also in suicidal behavior, but few studies have examined the relationship between suicidal behaviors and the HPA axis function in bipolar disorder, attending to and minimizing confounding factors. We compare HPA axis activity in bipolar individuals with and without suicidal behavior and unaffected healthy controls through measurement of salivary cortisol.
Salivary cortisol was collected for three consecutive days in 29 controls, 80 bipolar individuals without a history of suicide and 56 bipolar individuals with a past history of suicide. Clinical factors that affect salivary cortisol were also examined.
A past history of suicide was associated with a 7.4% higher bedtime salivary cortisol level in bipolar individuals. There was no statistical difference between non-suicidal bipolar individuals and controls in bedtime salivary cortisol and awakening salivary cortisol was not different between the three groups.
The measure of salivary cortisol was a home based collection by the study subjects and the retrospective clinical data was primarily based on their historical account.
Bipolar individuals with a past history of suicidal behavior exhibit hyperactivity in the HPA axis. This biological marker remains significant regardless of demographic factors, mood state, severity and course of illness. This finding in bipolar disorder is consistent with the evidence for altered HPA axis functioning in suicide and mood disorders and is associated with a clinical subgroup of bipolar patients at elevated risk for suicide based on their history, and in need of further attention and study.

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Available from: Scott A Langenecker, Mar 11, 2014
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    • "Study designs included one case report (Kerner et al., 2013), seven transversal studies (Goldstein et al., 2012; Kheirabadi et al., 2012; Undurraga et al., 2012; De Abreu et al., 2012; Algorta et al., 2011; Evans et al., 2012; Gomes et al., 2010), nineteen cohort studies (Parmentier et al., 2012; Huber et al., 2014; Ruengorn et al., 2012; Etain et al., 2013; Cassidy, 2011; Baldessarini et al., 2012; Bellivier et al., 2011; Sears et al., 2013; Jiménez et al., 2013; Leon et al., 2012; Finseth et al., 2012; Oquendo et al., 2010; Kenneson et al., 2013; Gilbert et al., 2011; Shabani et al., 2013; Pompili et al., 2012; Acosta et al., 2012; Song et al., 2012; Suttajit et al., 2013), and fifteen case-control studies (Eroglu et al., 2013; Antypa et al., 2013; Ryu et al., 2010; Manchia et al., 2013; Neves et al., 2010; Magno et al., 2011; Yoon et al., 2011; Arias et al., 2013; Clements et al., 2013; Pawlak et al., 2013; Kamali et al., 2012; de Moraes et al., 2013; Azorin et al., 2013; Dervic et al., 2011; Pawlak et al., 2013). The 42 studies were distributed into the previously determined six categories as follows: Risk factors associated with sociodemographic components (seven studies) (Huber et al., 2014; De Abreu et al., 2012; Ruengorn et al., 2012; Algorta et al., 2011; Cassidy, 2011; Antypa et al., 2013; Ryu et al., 2010); Risk factors associated with genetic components (six studies) (Manchia et al., 2013; Sears et al., 2013; Neves et al., 2010; Magno et al., 2011; Jiménez et al., 2013; Kerner et al., 2013); Risk factors associated with Medicines and Drugs in general that interfere with bipolar disorder (eight studies) (Bellivier et al., 2011; Yoon et al., 2011; Leon et al., 2012; Arias et al., 2013; Clements et al., 2013; Finseth et al., 2012; Oquendo et al., 2010; Kenneson et al., 2013); Risk factors associated with Biological components (three studies) (Kamali et al., 2012; Evans et al., 2012; Gomes et al., 2010); Risk factors associated with Psychological causes (seven studies) (Parmentier et al., 2012; Shabani et al., 2013; Pompili et al., 2012; Acosta et al., 2012; Song et al., 2012; Suttajit et al., 2013; Stewart et al., 2009); and Risk factors associated with components of Religious and Spiritual (three studies) components (Azorin et al., 2013; Dervic et al., 2011; Pawlak et al., 2013). Among the 42 studies, 8 discussed about " suicide risk factors in Bipolar Affective disorder " — more broadly (Goldstein et al., 2012; Eroglu et al., 2013; Kheirabadi et al., 2012; Undurraga et al., 2012; Etain et al., 2013; Baldessarini et al., 2012; Pawlak et al., 2013; Gilbert et al., 2011), being refered in more than one category. "
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    • "Investigations of the relationship between impulsivity and stress regulation are important for a better understanding of the role of stress in addiction (Takahashi, 2010; Takahashi et al., 2010; Bruijnzeel, 2012), in antisocial behavior (Vaillancourt and Sunderani, 2011), and in suicidal behavior (Kamali et al., 2012). The key system in the stress response is regulated by the faster activity of the adrenergic neurotransmitters (i.e. the sympatho-adrenomedullary [SAM] system) and the slower activity of the glucocorticoid hormone system "
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