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For more on childhood adversity and bipolar disorder see Br J Psychiatry 2016, published online Oct 6 2016. http://dx.doi.org/10·1192/bjp. bp.115·179655 For more on SSRIs in pregnancy and offspring development see JAMA Psychiatry 2016; 73: 1163–70 For more on cerebral hypoperfusion and dementia risk see PLoS Med 2016; 13: e1002143 For more on trauma and adjustment disorder see Am J Psychiatry 2016, published online Oct 24. http://dx.doi.org/10·1176/appi. ajp.2016·16010071 For more on insomnia, social disconnection, and suicidality see J Affect Disord 2016; 208: 153–62 For more on shared genetic risks of bipolar disorder and ADHD see Biol Psychiatry 2016, published online Oct 18. http://dx.doi.org/10·1016/ j.biopsych.2016·08·040
Childhood adversity and bipolar disorder
Cerebral hypoperfusion and dementia risk
Insomnia, social disconnection, and suicidality
The association between childhood adversity and the later development of bipolar disorder has been analysed in a meta-analysis of 19 studies. Researchers noted that people with bipolar disorder were more likely to have experienced childhood adversity than unaffected control individuals (odds ratio [OR] 2·63, 95% CI 2·00–3·47, p<0·001), a lthough evidence of study heterogeneity (I²=77%) was found. Emotional abuse in childhood imparted the greatest risk for later developing bipolar disorder (OR 4·04, 95% CI 3·12–5·22, p<0·001), followed by physical abuse (2·86, 2·22–3·69, p<0·001), although some evidence of study heterogeneity for the analysis of physical abuse (I²=70%) was noted.
Using data from 6204 individuals from the longitudinal populationbased Rotterdam Study, the Heart Brain Connection Collaborative Research Group has examined the associations between orthostastic hypotension and the development of dementia. At baseline, participants had a mean age of 68·5 years and were free from stroke and dementia; 1152 had orthostatic hypotension. Over a median of 15·3 years follow-up there were 1176 incident cases of dementia. Compared with people who did not have orthostatic hypotension at baseline, researchers suggested that orthostatic hypotension was associated with a greater risk of dementia (adjusted HR 1·15, 95% CI 1·00–1·34; p=0·05), with the risk being more pronounced in individuals without a compensatory increase in heart rate.
Researchers have attempted to disentangle the associations between insomnia, thwartedbelongingness, and suicidality. Using cross-sectional data from 469 US students, researchers showed that the presence of insomnia was associated with thwarted belongingness (b=0·66, SE=0·09, p<0·001), which in turn was a predictor for suicidal ideation (b=0·13, SE=0·02, p<0·001); additional analysis suggested the links between insomnia and suicidality were mediated by thwarted belongingness. These results were supported by analysis of data from two other cross-sectional cohorts and also using longitudinal data from 217 primary care patients followed for 6–12 months.
Trauma and adjustment disorder
Using GWAS data, researchers have investigated whether the frequent comorbidity of bipolar disorder and attention deﬁcit hyperkinetic disorder (ADHD) could be explained by genetic overlap. In their study, Van Hulzen and colleagues included data from individuals with ADHD (n=4609), bipolar disorder (n=9650), and also control participants (n=21 363). Having established genetic correlation (r G) between the two disorders (rG=0·64, p=3·13 × 10–14), investigators did a cross-disorder meta-analysis, which indicated particular signiﬁcance of regions located within genes on chromosome 6 (CEP85L; p=4·36 × 10–8) and chromosome 10 (TAF9BP2; p=2·47 × 10 –8 ). When analyses were limited to overlap of ADHD with early-onset bipolar disorder (rGrestricted=0·71, p=4·09 × 10–16), cross disorder meta-analysis suggested signiﬁcant association in a region on chromosome 5 (ADCY2; p=2·47 × 10–8).
SSRIs in pregnancy and oﬀspring development The potential risks of prenatal selective serotonin reuptake inhibitor (SSRI) exposure on offspring development have been examined in a Finnish cohort study. Researchers included data for 56 340 mother–child pairs in their study; 25 133 women had a depression-associated diagnosis, of whom 15 596 were exposed to SSRIs during pregnancy. Compared with the offspring of unaffected women, researchers found increased risks of speech or language disorders in offspring of SSRI-exposed (adjusted hazard ratio [HR] 1·53, 95% CI 1·26–1·86; p<0·001) and SSRIunexposed women with depressionassociated disorders in pregnancy (1·28, 1·03–1·58; p=0·02), over 14 years of follow-up. Further analysis showed a greater risk of speech or language disorders in oﬀspring of mothers who had made two or more purchases of SSRIs in pregnancy compared with pregnant women who had a depression-associated diagnosis but had not received SSRIs (HR 1·37, 95% CI 1·11–1·70; p=0·004).
The occurrence and sequelae of adjustment disorder following injury have been examined in a longitudinal cohort study by O’Donnell and colleagues. With data from the Australian Injury Vulnerability Study, researchers noted that at 3 months after injury, adjustment disorder occurred in 178 (19%) of 929 participants, decreasing to 135 (16%) of 826 at 12-month followup; over half of the cases of adjustment disorder at 12 months represented new diagnoses. Compared with postinjury participants who did not have a psychiatric diagnosis at 3 months, participants with an adjustment disorder at 3 months were more likely to be diagnosed with a diﬀerent psychiatric disorder at 12-month follow-up (OR 2·67, 95% CI 1·59–4·49; p<0·001), and had worse outcomes at 3 months for quality of life, disability, and depression and anxiety scores (p<0·001 for all comparisons).
Shared genetic risks of bipolar disorder and ADHD
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