Article

# 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

[more]
The University of Michigan, Department of Psychiatry and Depression Center, Ann Arbor, MI 48109-2700, USA.
(Impact Factor: 3.38). 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.

### Full-text

Available from: Scott A Langenecker, Mar 11, 2014
0 Followers
·
• Source
• "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. "
##### Article: Risk factors for suicide in bipolar disorder: A systematic review
[Hide abstract]
ABSTRACT: Background Bipolar disorder confers the highest risk of suicide among major psychological disorders. The risk factors associated with bipolar disorder and suicide exist and are relevant to clinicians and researchers. Objective The aim of the present study was to conduct a systematic review of articles regarding the suicide risk factors in bipolar disorder. Methods A systematic review of articles on suicide risk factors in bipolar disorder, published from January 1, 2010 to April 05, 2014, on SCOPUS and PUBMED databases was carried out. Search terms were "Suicide" (medical subject headings [MeSH]), "Risk factors" (MeSH), and "Bipolar" (keyword). Of the 220 retrieved studies, 42 met the eligibility criteria. Results Bipolar disorder is associated with an increased rate death by suicide which contributes to overall mortality rates. Studies covered a wide range of aspects regarding suicide risk factors in bipolar disorder, such as risk factors associated to Sociodemographic conditions, Biological characteristics, Drugs Relationships, Psychological Factors, Genetic Compound, Religious and Spirituals conditions. Recent scientific literature regarding the suicide risk factors in bipolar disorder converge to, directly or indirectly, highlight the negative impacts of risk factors to the affected population quality of life. Conclusion This review demonstrated that Bipolar disorders commonly leads to other psychiatric disorders and co-morbidities involving risk of suicide. Thus the risk factors are relevant to have a better diagnosis and prognosis of BD cases involving risk of suicide.
Journal of Affective Disorders 09/2014; 170C:237-254. DOI:10.1016/j.jad.2014.09.003 · 3.38 Impact Factor
• Source
• "Depression . Depression is another rapidly growing area of research that has included salivary cortisol measures quite often ( Burke et al . , 2005 ; Kamali et al . , 2011 ; Knorr et al . , 2010 ; Lok et al . , 2011 ) . Lok et al . ( 2011 ) found that individuals with major depressive disorder ( MDD ) followed longitudinally over 2 years and compared with control persons over the same time had consistently higher cortisol concentrations irrespec - tive of stress . In 2005 , Burke et al . conducted a meta "
##### Article: Salivary cortisol measurement in developmental research: Where do we go from here?
[Hide abstract]
ABSTRACT: Salivary cortisol has been measured extensively in developmental research over the last three decades. The purpose of this article is to summarize the contributions to and limitations of salivary cortisol measurement in developmental research and propose future directions for research that includes salivary cortisol measurement. The properties of cortisol, the history of its burgeoning popularity, and the utility and limitations of (a) cortisol as a biological indicator, (b) saliva as a source of cortisol, and (c) various saliva collection methodologies are described. The current state of understanding about what is and is not reliably predictable from cortisol is summarized and the value of salivary cortisol measurement in developmental research is discussed, addressing whether methodology could be driving research design. Recommendations are made for streamlining study design and reporting within developmental research. © 2012 Wiley Periodicals, Inc. Dev Psychobiol.
Developmental Psychobiology 04/2013; 55(3). DOI:10.1002/dev.21025 · 3.31 Impact Factor
• Source
• "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 "
##### Article: DNA polymorphism in the FKBP5 gene affects impulsivity in intertemporal choice
[Hide abstract]
ABSTRACT: Impulsivity in intertemporal choice has been operationalized as "delay discounting", referring to the preference for a sooner, smaller reward. FK506 binding protein 5 (FKBP5) is a co-chaperone of the glucocorticoid receptor (GR). FKBP5 overexpression causes GR resistance, resulting in increased plasma cortisol levels. High cortisol levels are associated with low impulsivity in intertemporal choice. The aim of this study was to explore the effect of single nucleotide polymorphisms (SNPs) in FKBP5 on delay discounting. The participants consisted of 91 healthy Japanese people (66 males and 25 females with a mean age of 40.9 ± 6.9 years). Each participant completed Kirby's monetary choice questionnaire (MCQ) and donated a whole blood sample. Five SNPs in FKBP5 were genotyped using the DigiTag2. SNP linear regression analyses with 100,000 permutations were conducted for the hyperbolic time-discount rate (k). Two SNPs were excluded from analysis because of their low minor allelic frequencies. The SNP rs1360780 showed a significant association; participants with more minor alleles (T) were less impulsive in intertemporal choice for delayed gain (multiplicity-corrected P = 0.047). The significant SNP rs1360780 is located in the region adjacent to the hormone response element (HRE)-binding sequence where transcription factors bind and alter the transcription of FKBP5. A minor allele (T) of rs1360780, which causes FKBP5 overexpression, may reduce impulsivity in intertemporal choice (i.e. delay discounting) via GR resistance and the subsequent high cortisol levels. This is the first study to demonstrate an association between FKBP5 and impulsivity in intertemporal choice.
Asia-Pacific Psychiatry 03/2013; 5(1):31-8. DOI:10.1111/appy.12009 · 0.63 Impact Factor