Non-suicidal Self-Injury (NSSI) refers to causing damage on body tissue without attending to death. It is mostly presented among the youths and not approved by the society. Studies nowadays have explored the perspectives, feelings or experience of the youths or healthcare professionals. However, negative feelings and misunderstandings toward each other remain from both sides.

The aim was to explore the encountering experience of the youths with NSSI and the healthcare professionals during the same hospitalization in a psychiatric acute ward.

Qualitative study was employed by using narrative approach. In-depth interview was conducted for the youths with NSSI and their primary nurse and resident from a medical center in southern Taiwan.

Narratives from the patients and healthcare professionals showed that the youths seemed to be comfortable as encountering with the healthcare professionals’ caring. In contrast, the healthcare professionals’ struggles had been hidden inside and remained uneasy and unsolved. Two extreme experiences have been reported by the youths with NSSI: felt satisfied and understood about being cared vs. felt numbness and not been understood. Four kinds of experience were identified as: struggling on caring them, feeling confused and helpless, keeping a safe distance, and having contradicted values.

This study found that the healthcare professionals suffer from varied aspects when encountering the youths with NSSI, which they often hid inside without expressing. Future improvement such as care guideline or staff’s support system should be built to decrease the negative effects inside the healthcare professionals’ mind.

No significant relationships.

In vivo and in vitro studies suggest that inflammation and oxidative damage may contribute to the pathogenesis of major depressive disorder (MDD) and bipolar disorder (BD). Imbalance between DNA damage and repair is an emerging research area examining pathophysiological mechanisms of these major mood disorders.

This systematic review sought to examine current evidence on the association between mood disorders and deficits in base excision repair (BER), the primary repair mechanism for repair of oxidation-induced DNA lesions.

We conducted a comprehensive literature search of Ovid MEDLINE® Epub Ahead of Print, Ovid MEDLINE® In-Process & Other Non-Indexed Citations, Ovid MEDLINE® Daily, EMBASE (1947), and PsycINFO for studies investigating the alterations in base excision repair in patients with MDD or BD.

A total of 1,364 records were identified. 1,352 records remained after duplicates were removed. 24 records were selected for full-text screening and a remaining 12 articles were included in the qualitative synthesis. SNPs (Single Nucleotide Polymorphisms) of several BER genes have been shown to be associated with MDD and BD. However, it was difficult to draw conclusions from BER gene expression studies due to conflicting findings and the small number of studies.

Future studies comparing DNA repair during the manic or depressive episode to remission will give us a better insight regarding the role of DNA repair in mood disorders. These alterations might be utilized as diagnostic and prognostic biomarkers as well as measuring treatment response.

No significant relationships.

Autism spectrum disorders (ASD) are a group of neurodevelopmental disabilities causing major social, communication, and behavioural challenges. Although causative roles of altered genes and environment are recognized, the underlying mechanisms remain elusive.

We carried out a longitudinal analysis of morphological correlates of synaptic plasticity in the cortex with an array of neuro-behavioural tests in Tsc2 loss-of-function ASD rats with persistent mTORC1 hyperactivity.

Dendritic spine density and morphology with astroglial response were analysed along with behavioural tests in 45 d.o., 90 d.o. and 12 m.o. age groups maintained under standard or enriched conditions.

We report a higher density of spines, with a bigger proportion of thin spines in 90 d. o. Tsc2+/- rats, while under enrichment the spine density in 12 m.o groups was lower. In behavioural tests, rats under enrichment showed higher activity in open arms and anogenital contact tests in the second and third age groups. They also showed enhanced self-grooming. Total distance travelled in the open field by Tsc2+/- rats was less in the first and second age groups. Confocal imaging showed an increase in pS6 expression in second and third Tsc2+/- groups, implying mTORC1 hyperactivity.

Our results show that the environment may have differential neuro-behavioural impacts in rats with unleashed mTORC1, in agreement with the two-hit mechanisms of the underlying neuro-behavioural effects in this model. Although the results of the morphometric analysis suggest a causal link between behavioural changes with altered synaptic plasticity, the mechanisms and involved signalling remain to be defined.

No significant relationships.

Aggression and violent incidents are a major concern in psychiatric inpatient care. Nutritional supplementation was found to reduce aggressive incidents and rule violations in forensic populations and in children with behavioral problems.

To assess whether multivitamin, mineral, and n-3 PUFA supplementation would reduce the number of aggressive incidents among long-stay psychiatric inpatients.

The trial was a pragmatic, multicenter, randomized, double-blind, placebo-controlled study. Data were collected from 25 July 2016 through 29 October 2019 at 8 local sites for mental healthcare in the Netherlands and Belgium. Participants were randomized (1:1) to receive either three supplements containing multivitamins, minerals, and n-3 PUFA or placebo for 6 months. The primary outcome was the number of aggressive incidents using the Staff Observation Aggression Scale – Revised (SOAS-R). Secondary outcomes were the patients’ quality of life, affective symptoms, and adverse events.

In total, 176 participants were randomized (supplements, n = 87; placebo, n = 89). Participants were on average 49.3 years old (SD = 14.5), and 64.2% were male. Most patients had a psychotic disorder (60.8%). The primary outcome of SOAS-R incidents was similar in those assigned to supplements (1.03 incidents per month; 95% confidence interval [CI]: 0.74-1.37) and placebo (0.90; 95% CI: 0.65-1.19), with a rate ratio of 1.08 (95% CI: 0.67-1.74; p = .75). Differential effects were not found in sensitivity analyses on the SOAS-R or on secondary outcomes.

Six months of nutritional supplementation did not reduce aggressive incidents among long-stay psychiatric inpatients.

No significant relationships.

Sleep disturbances (SDs), such as insomnia or regular nightmares, are associated with multiple mental health disorders, most notably PTSD, where SDs are reported in up to 92% of cases. Examining the effect of changing sleep on psychological symptomology is essential to develop the evidence base on the contribution of sleep to mental resilience.

To examine the effect a short skills-based sleep intervention on psychological symptomology and actigraphy measured sleep.

A 4-session sleep skills training programme was used to treat active SDs in participants likely to have experienced occupation-associated trauma, namely military and first responders.

Nineteen participants were included in the study. Insomnia Severity Index (ISI) measured; difficulty sleeping, difficulty staying asleep, waking too early, sleep satisfaction, sleep interference on quality of life and total ISI insomnia score improved significantly post-treatment (M = 9.44, SE = 7.35, p <0.001). No significant difference was identified post-treatment for actigraphy-measured sleep. The severity of depression (M = 5.27, SE = 1.41, p = 0.002), anxiety (M = 5.07, SE = 1.66, p = 0.008), and PTSD symptoms among participants with likely PTSD, were significantly lower following treatment (M = 29.4, SE = 4.19, p = 0.002).

A short sleep skills intervention based on CBT-I was effective at reducing self-report insomnia symptoms and severity of psychological symptomology but failed to improve actigraphy sleep metrics. These findings highlight a differing contribution of night-time sleep and current insomnia symptoms to the severity of self-reported psychological symptomology.

No significant relationships.

People with autism spectrum disorder (ASD) frequently need support due to the elevated prevalence of psychiatric and medical comorbidities. The Covid-19 outbreak has severely affected the routinary functioning of healthcare services, thus causing severe consequences for autistic people and their caregivers, an already fragile population prone to mental health diseases.

1. To compare the levels of psychological well-being, insomnia, and family distress perceived by caregivers of autistic people to those perceived by caregivers of people with other types of disability. 2. To evaluate predictors of individual and family distress reported by caregivers of autistic individuals.

We collected data through a cross-sectional web-based observational study from April 19 to May 3, 2020. Socio-demographic information were collected, and psychopathological variables were assessed using the General Health Questionnaire-12, the Insomnia Severity Index, the Brief Resilient Coping Scale, and the Family Distress Index.

No significant differences emerged between the two groups of caregivers in terms of well-being, sleep quality, family distress, and level of resilience. The risk of individual distress during the pandemic was higher in people caring for younger autistic people. Lower levels of resilience predicted higher levels of individual distress among caregivers of autistic people.

Our study confirmed that caregivers’ mental health is worthy of attention and that people with disabilities may benefit for well-organized healthcare support networks (e.g. in-home services). The non-significant differences found between caregivers of ASD and non-ASD individuals may be related to the severe distress that Covid pandemic caused on the entire population.

No significant relationships.

Schizophrenia spectrum disorders may severely limit ability to achieve and maintain gainful employment of affected working-age individuals.

Assess the employment status in patients with schizophrenia spectrum disorders treated with long acting injectable paliperidone palmitate after the switch from oral antipsychotics.

A single centre mirror image design study of 115 patients with schizophrenia spectrum disorder was conducted in a tertiary level psychiatric hospital. Data were collected for period of 12 months prior toand 12 months after switching from oral antipsychotic to long acting injectable paliperidone.Employment status for 6 enrolled patients was missing.

Mean age of enrolled patients was 38,4±11,6 years. Of the 109 patients analyzed for employment status, 44,4% remained employed for 12 months after switching to long acting injectable paliperidone while 4,6% patients changed their employment status from unemployed to employed after the switch. No patient changed their employment status from employed to unemployed after the switch. 9,2% patients were already retired at the beginning of study period and 5,5% of patients maintained their student status. 36,7% patients remained unemployed for the whole study period. The correlation between employment status of employed and unemployed patients and duration of illness was borderline significant with p=0,049.

The data from this study suggest that use of long acting injectable paliperidone contributed to preservation of working ability of working-age patients suffering from schizophrenia spectrum disorders.

No significant relationships.

During the COVID-19 pandemic time, teachers have to adapt to many changes that could potentially make them more vulnerable to psychological distress.

To determine the prevalence and the factors for anxiety during the COVID-19 epidemic among the high school teachers in Sfax, Tunisia.

This was a cross-sectional study, for descriptive and analytical purposes, conducted on google drive in May 2021.We involved 97 junior and secondary school teachers from Sfax, Tunisia, practicing in public high schools. Anxiety was assessed by using Generalized Anxiety Disorder tool (GAD-7).

The average age of the participants was 44.23 years old with a sex-ratio (M/F) of 0.32. Since the advent of COVID-19, 54.2% had presented sleep disturbances while 10.4% had suicidal thoughts. Among all participants, 77.8% were afraid of the virus transmission within the classroom or the school and 81.3% reported regular mask wear at work. The median score on the GAD-7 was 6.5 (Q1=3, Q3=11). Scores’ distribution indicated that 68% of the participants had no to mild symptoms of anxiety while 32% had moderate to severe anxiety. Furthermore, the presence of anxiety was associated to the female gender (p=0.01), sleep disturbances (p<0.001), suicidal thoughts (p=0.006), and to the conviction that wearing masks blocks the transmission of voice, information or emotions between teacher and student (p=0.025).

During the COVID-19 outbreak, high school teachers in Sfax, Tunisia have high levels of anxiety.This can lead to a decreased effectiveness of their complex work.

No significant relationships.

As all first line options in treating First Episode Psychosis (FEP) are similarly effective there is a consensus among prescribing guidelines that clinicians and patients should consider side-effect profile as the ‘driver’ of initial choice of antipsychotic. Anecdotally it has been observed that different care teams prescribe particular medications preferentially.

To evaluate the patterns of antipsychotic prescribing in patients with FEP at the time of initial treatment and over the first year with the Early Intervention Service (EIS).

Medical records of all patients who had completed 1 year of follow-up with EIS in Sussex Partnership Foundation Trust (n=274) were reviewed. The first antipsychotic prescribed and antipsychotic prescribed at 12-months was recorded alongside initiating care team (EIS, non-EIS community services, inpatient services).

99% (n=272) of patients were prescribed an antipsychotic. 46% were initiated by inpatient serves, 40% non-EIS community services and 14% EIS. Aripiprazole, olanzapine, quetiapine and risperidone accounted for 95% of initial prescriptions. Different care teams prescribed antipsychotics preferentially (p=<0.005) (Fig.1). Rates at which initial medication was continued at 12-months varied according to initial prescription (P=<0.05) (Fig.2).

The frequency that specialist EIS services prescribed aripiprazole as initial treatment contrasts the preference for olanzapine in other services. Olanzapine has a significant metabolic side effect profile, is sedating and was least likely to be continued at 12 months. This raises questions about why non-FEP specialist services prefer olanzapine and whether EIS services can support these services around initial medication choices more likely to be continued throughout the key first year of treatment.

No significant relationships.

The peripartum is a period at high risk for the onset of depressive symptoms. The prevalence of peripartum depression (PD) ranges from 6 to 20% and is burdened with high adverse birth outcomes, poor mother-infant bonding, and a high risk for suicidal ideation and attempts. However, PD is underrecognized and consequently undertreated.

We aimed at screening depressive symptoms in women during pregnancy and postpartum, and evaluating the socio-demographic and clinical characteristics associated with depressive symptoms.

199 women, 55 during pregnancy and 144 in the postpartum period, consecutively admitted to the Perinatal Mental Health Service of Ancona (Italy) were administered a socio-demographic and clinical questionnaire together with the Edinburgh Postnatal Depression Scale (EPDS). Women scoring ≥ 12 at the EPDS were considered screening positive.

Twenty women (10%) were screening-positive. These women were more often foreigners (R2=0,032; β=0,178; p=0,012), single (R2=0,026; β=0,163; p=0,022), with a positive psychiatric family history (R2=0,114; β=-0,337; p=0,001) and more frequently affected by physical comorbidities unrelated to pregnancy (R2=0,03; β=0-0,174; p=0,014). These women also had more gestational comorbidities such as gestational hypertension (R2=0,02; β=-0,154; p=0,030), shortening of uterus neck (R2=0,05; β=-0,234; p=0,001), and miscarriage threats/placental abruption (R2=0,004; β=-0,067; p=0,001).

Our study highlighted the association between depressive symptoms and potentially dangerous gestational comorbidities. Our results further stress the need to screen all women in the peripartum for the presence of depression, in order to identify those at-risk and eventually put in place strategies to prevent further complications to mothers and children.

No significant relationships.

It is important to know the prevalence of the Early Maladaptives Schemas (EMS) in such population.

The study of Early Maladaptives Schemas among call center staff in the Rabat Sale Kenitra region and possible socio-economics factors that may influence them.

The study involved 121 call center’s employees in the Rabat Sale Kenitra region. They responded to an informative questionnaire and to the SPI 26, with 26 items, including 13 early maladaptives schemas.

121 subjects were interviewed, 48.78% (n=59) men and 51.24% (n=62) women, a minimum age of 22 years, a maximum age of 60 years and an average of 31.74 7.93. Through the examination of the EMS’s results in adulthood, we note a decreasing ranking of active shemas according to the rate of participants: the EMS Unrelenting standards is active in 80.02% of our sample, the EMS Mistrust in 61,2%, the EMS Insufficient self-control in 47.9%, the EMS Abandonment in 47.1%, the EMS Insufficient self-control in 41.3%, the EMS Emotional inhibition in 38.8%, the EMS Vulnerability to harm or illness in 33.1%, the EMS Dependence in 31.4%, the EMS Selfsacrifice in 27,3%, the EMS Social Isolation in 19%, the EMS Emotional deprivation in 10.7%, the EMS failure in 8.3% and the EMS Enmeshment in 7,4%.

By comparing the rates of EMS in childhood and adulthood, it emerges that only the EMS Abandonment, Dependence and Insufficient self-control showed a disinensification, increasing successively from adulthood to childhood as follow :from 69.4% to 47.1% , from 52,9% to 31.4% and from 59.5% to 47.9%.

No significant relationships.

The use of internet among children and adolescent has risen in the last decade. In addition, suicide is the second cause of death among adolescents. Previous research have indicated the relation between Problematic Internet Use (PIU) and different mental health problems. Nonetheless there is a lack of studies analyzing the relation between suicide behaviour and PIU

The main objective of the present work was to analyze the relation between Problematic Internet Use and suicide behaviour and depression in adolescents

A total of 1036 adolescents (450 males) were randomly selected. Mean age was 15,21 (SD = 1,23). The Adolescent Behavioural Suicide Scale SENTIA, The Reynolds Adolescent Depression Scale Short Form (RADS-SF), and The Compulsive Internet Use Scale (CIUS) were used. A Manova was performed with two groups (risk and non-risk to PIU) as independent variables and suicide and depression scores as dependent variables

The results revealed a statiscally signifficant association between PIU and both depression and suicide behaviour (λ = 0.245, F(2,81,000) = 15.549, P ≤ 0.001, η² = 0.116). In particular, adolescents at a higher risk for PIU obtained higher scores on suicide behaviours and depression.

Results found in the present study reveal that adolescents have moderate prevalence rates for PIU. Also adolescents at risk for PIU with a total of more than 3 hour sof internet use everyday were at a higher risk for suicide. Prevention strategies should be devote to intervene in internet use as it maybe a variable affecting suicide behaviour.

No significant relationships.

Body image dissatisfaction entails an activity, which is nothing else but an attempt for deliberate regulation of their body. It has different kinds and manifestations. Most researchers focus on such body regulation practices as weight control, muscles build-up, or cosmetic surgery.

Our goal is to work out a psychological hierarchical model of body regulation practices aimed at abating a person’s dissatisfaction with their body image.

Using a method of agglomerative hierarchical clustering, we carried out a multivariate classification of 122 respondents’ answers to the Body Regulation Practices Survey (E. Nikolaev), which allows establishing the frequency of the respondents’ use of each of the 11 variants of body regulation practices offered in the survey.

Based on the results of 11 variables of a dendrogram, we established two data arrays, combining correspondingly 4 and 7 versions of body regulation practices. The first array comprises two pairs of clusters – physiological practices and weight control, as well as practices of personality and spiritual development. We identified it as “developmental body regulation practices”. The second array includes two paired clusters – aesthetic medicine and body modifications; image making and hetero-aggressive practices. Merging with the four practices mentioned above on a higher level of the hierarchy are auto-aggressive and inertial practices. We identified this array as “compensatory – non-adaptive body regulation practices”.

The devised model can become the basis for further advanced research in the area of body regulation in cases of dissatisfaction with body image.

No significant relationships.

To improve the effectiveness of treatment for atypical depression, it is necessary to revise the accumulated experience, taking into account new knowledge and drugs.

Comparative study of the efficacy and safety of therapy for atypical depression (AtD) in the structure of bipolar affective disorder (BAD), recurrent depressive disorder (RDR) and psychogenic depression (PD).

Clinical and clinical follow-up methods examined 77 patients with AtD, of which 35 - with bipolar disorder, 18 - with RDR and 24 - with PD. Patients in all three groups received monotherapy with an antidepressant or a mood stabilizer, or a combination of antidepressant and antipsychotic, antidepressant and mood stabilizer, mood stabilizer and antipsychotic, as well as a combination of antidepressant, antipsychotic and mood stabilizer.

Agomelatine was the most frequently used (27.3%) and effective in reducing MADRS in all groups both in monotherapy and in combination with other drugs. Also in the PD group, escitalopram and vortioxetine were highly effective. Of the antipsychotics, when combined with antidepressants, sulpiride was found to be the most effective. When comparing the tolerance of antidepressants in all groups showed the best results (by the CGI scale), agomelatine and venlafaxine, in the BAR group is also vortioxetine.

The best strategy for effective and safe treatment of atypical depression is the use of modern antidepressant, which does not increase the symptoms of the atypical spectrum and, if necessary, can be supplemented with some antipsychotics.

No significant relationships.

Bipolar disorder (BD) is a chronic and recurrent illness frequently associated with functional deterioration and treatment challenges. High rates of thyroid dysfunction have been found in patients with BD, compared to the general population.

To illustrate through a case-report the therapeutic challenges of treatment-resistant bipolar disorder and its relationship with thyroid dysfunction.

Case report of a 41-year-old male patient with BD and comorbid anxiety disorders who has been diagnosed with thyroid cancer and underwent total thyroidectomy.

Mr B is a 41 year old patient diagnosed with BD and comorbid anxiety disorders (panic disorder, social anxiety disorder and generalized anxiety disorder) at age 18. He has presented in total 17 relapses and was hospitalized 7 times between the ages of 18 and 24. He experienced predominantly major depressive episodes with mixed features and debilitating anxiety symptoms. He was put on several treatments including a combination of mood stabilizers, antidepressants and benzodiazepines. Due to unsatisfactory treatment response, he was put on clozapine 150mg to 175mg/d combined with valproic acid, clonazepam. In 2009, the patient developed a nodular goiter caused by papillary thyroid carcinoma and underwent total thyroidectomy and radioactive iodine therapy. Following the surgical operation and stabilization of thyroid functioning, a decrease in the number of relapses and the severity of mood and anxiety symptoms have been noted.

This case reports highlights the importance of thyroid function assessment in patients with bipolar disorder and the possible correlation to treatment resistance and symptom severity.

No significant relationships.

The Chornobyl catastrophe (ChC) has impacted on depopulation and mental health of the survivors, however, the rate of demographic aging and mental health survey remain at issue.

To determine the rate of demographic aging of ChC survivors and to analyze the state of their mental health survey.

Information from the Ministry of Health and the State Statistics Service of Ukraine, Clinical and Epidemiological Register, the State Register of ChC survivors, and clinical neuropsychiatric data were analyzed.

In 2018, compared to 1995, the number of the ChC survivors decreased by 987 thousand with high level of aging: ChC clean-up workers – 59.0%; evacuees – 25.0%, and residents of radioactively contaminated territories (RCT) – 30.7%. There are negative tendencies in age parameters of survival of the RCT population. Long-term mental health disorders and neuropsychiatric effects in the ChC survivors have been identified, which may indicate an accelerated aging. Neurophysiological and molecular-biological atypia of aging processes under an exposure to low doses of and low dose rate of ionizing radiation have been found. Existing statistical and registry data underestimate the level of mental disorders in the population of Ukraine, including the ChC survivors by an order of magnitude.

The negative tendencies in age parameters of survival indicate the need to continue research to identify the factors “responsible” for such changes. Mental health disorders and neuropsychiatric effects in the ChC survivors are underestimated. It is necessary to create a national psychiatric registry of Ukraine and long-term (lifelong) monitoring of survivors.

No significant relationships.

Non-suicidal self-injury (NSSI) is associated with emotional distress and mental disorders. In clinical samples NSSI is reported by 21% to 60% of all psychiatric patients. Developed NSSI instruments are not suitable for clinical settings because they are too time-consuming or lack validation across psychiatric diagnoses.

The Transdiagnostic Self-Injury Interview (TSI) is semi-structured interview that accesses onset, frequency, methods, and severity of NSSI. It is transdiagnostic and developed for clinical settings.

The purpose of the study is to evaluate the feasibility of a TSI validation study. The study will also provide preliminary validation of the instrument.

The feasibility study will recruit participants at in- and outpatient units from a university hospital. Participants can be included in the study if they are 18 years old and admitted to a psychiatric in- or outpatient unit.

Instruments: The Deliberate Self-Harm Inventory will be used to test concurrent validity. Convergent validity will be tested with the Columbia Suicidality Severity Rating Scale, the Personal and Social Performance scale, the Affective Lability Scale-short, and the Brief Trauma Questionnaire. Interrater reliability will be evaluated in groups of medical doctors, psychologist, and other clinical professionals.

Feasibility are measured by inclusion of participants per week, the time each participant takes to complete the study instruments, and number of dropouts.

Recruitment of participants will start in the fall of 2021. We aim to recruit 50 participants.

When TSI has been validated, it can be used to assess prevalence and severity of NSSI and clarify the need for treatment and supervision.

No significant relationships.

Catenin alpha 2 gene (CTNNA2) is important in the stability of hippocampal synapses and also in brain development. Our recent paper (Eszlari et al, Pharmaceuticals 2021, 14, 850) has demonstrated that rumination on sad mood mediates the association of CTNNA2 only towards psychiatric symptoms, but not towards cardiovascular risk phenotypes.

Our present aim was to test the moderating role of rumination and its two subtypes, brooding and reflection, in genetic associations between CTNNA2 and the same cardiovascular risk phenotypes.

633 unrelated subjects from the Budakalasz Health Examination Survey with non-missing phenotypic data, and 160 single-nucleotide CTNNA2 variants remaining after quality control, were included. Linear regression models were run in Plink 1.9 for separate outcomes of body mass index (BMI), and Framingham risk scores for cardiovascular disease, coronary heart disease, myocardial infarction, and stroke. With each variant, predictors were the variant, rumination or its subtype, the variant x rumination interaction, sex, age, and the top ten principal components of the genome. 100,000 label-swapping max(T) permutation was applied for the interaction term within each analysis.

While no significant interaction term survived the familywise permutation, two trends emerged. Namely, BMI seems to have positive association with rumination and its maladaptive brooding subtype only in case of GG genotype of rs13412541, otherwise no association can be detected.

Although replication is needed in larger samples, the relationship between rumination and BMI, conditional on CTNNA2 genotype, can be important in atypical depression, thus may contribute to stratification of depressed patients.

The study was supported by the New National Excellence Program of the Ministry for Innovation and Technology from the source of the National Research, Development and Innovation Fund (ÚNKP-21-4-II-SE-1); and by 2019-2.1.7-ERA-NET-2020-00005.

No significant relationships.

Osteoporosis, a systemic skeletal disorder associated with substantial morbidity and mortality, has been suggested to be particularly common among individuals with bipolar disorder. Lithium, a mood-stabilizer used as first-line treatment for bipolar disorder, may have bone-protecting properties.

We aimed to subject both of these hypotheses to further examination in a nationwide register-based study.

We compared the incidence of osteoporosis, identified via hospital discharge diagnoses and prescribed medications, between all individuals diagnosed with bipolar disorder and age- and sex-matched controls from the general population (earliest start of follow-up at the age of 40 years) using Cox regression. Subsequently, we followed the patients with bipolar disorder and identified all prescriptions for mood-stabilizing medications. Using Cox regression, we compared the incidence of osteoporosis for patients using lithium, antipsychotics or anticonvulsants, respectively, with that of patients not using these medications.

We followed 22,912 patients with bipolar disorder (median age 50.4 years, 43.4% men) and 114,560 matched controls for 1,215,698 person-years. The incidence of osteoporosis per 1,000 person-years was 8.70 (95%CI:8.28-9.14) among patients with bipolar disorder and 7.84 (95%CI:7.67-8.01) among controls, resulting in a hazard rate ratio (HRR) of 1.15 (95%CI:1.09-1.21). Lithium treatment was associated with reduced risk of osteoporosis (HRR=0.62; 95%CI:0.53-0.72) in a treatment-duration-response-like manner. Treatment with antipsychotics and anticonvulsants was not associated with reduced risk of osteoporosis.

This is the first longitudinal study to show that the risk of osteoporosis is elevated among patients with bipolar disorder, and that treatment with lithium is associated with reduced risk of osteoporosis.

Dr. Østergaard has received the 2020 Lundbeck Foundation Young Investigator Prize. Furthermore, SDØ owns units of mutual funds with stock tickers DKIGI, DKIDKIX, MAJGRO, NBIDE, SPIC20CAPK, SPVILRKL and WEKAFKI.