BackgroundPatients with major depressive disorder (MDD) usually have high risk of suicidality. Few studies have investigated the effects of stressful life events (SLEs) on the risk of suicide in Chinese patients who have developed MDD. This study aimed to investigate the impact of SLEs on suicidal risk in Chinese patients with MDD.

MethodsIn total, 1029 patients with MDD were included from nine psychiatric hospitals to evaluate the impact of SLEs on suicidal risk. Patients fulfilling the Mini-International Neuropsychiatric Interview (MINI) criteria for MDD were included in the study. Patients were excluded if they had lifetime or current diagnoses of psychotic disorder, bipolar disorder, and alcohol or substance dependence. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). The suicidal risk of MDD patients was determined by the suicide risk module of MINI. SLEs were assessed by the Life Events Scale.

ResultsNo gender difference was found for suicidal risk in MDD patients. Patients with suicidal risk had younger ages, lower education levels, more drinking behavior, and lower marriage rate, and fewer people had child and more severe depressive symptoms than nonsuicidal risk group. High-level perceived stressfulness (HPS) and number of SLEs that patients were exposed to were significantly greater in patients with suicidal risk than patients without. In multivariate logistic analysis, HPS of SLEs (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.05, P = 0.003) and depressive symptoms (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) were associated with suicidal risk even after adjustment of gender, age, marriage, drinking behavior, and childless.

ConclusionsHPS of SLEs is associated with suicide risk in Chinese patients with MDD. Further suicide prevention programs targeting this risk factor are needed.

Trial RegistrationClinicalTrials.gov: NCT02023567; https://clinicaltrials.gov/ct2/show/NCT02023567?term=NCT02023567&rank=1.

Adolescent ; Adult ; Asian Continental Ancestry Group ; Bipolar Disorder ; epidemiology ; psychology ; Depressive Disorder, Major ; epidemiology ; psychology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Psychiatric Status Rating Scales ; Risk Factors ; Suicide ; psychology ; statistics & numerical data ; Young Adult

OBJECTIVE: This study was aimed to compare the accuracy of Support Vector Machine (SVM) and Gaussian Mixture Model (GMM) in the detection of manic state of bipolar disorders (BD) of single patients and multiple patients. METHODS: 21 hospitalized BD patients (14 females, average age 34.5±15.3) were recruited after admission. Spontaneous speech was collected through a preloaded smartphone. Firstly, speech features [pitch, formants, mel-frequency cepstrum coefficients (MFCC), linear prediction cepstral coefficient (LPCC), gamma-tone frequency cepstral coefficients (GFCC) etc.] were preprocessed and extracted. Then, speech features were selected using the features of between-class variance and within-class variance. The manic state of patients was then detected by SVM and GMM methods. RESULTS: LPCC demonstrated the best discrimination efficiency. The accuracy of manic state detection for single patients was much better using SVM method than GMM method. The detection accuracy for multiple patients was higher using GMM method than SVM method. CONCLUSION: SVM provided an appropriate tool for detecting manic state for single patients, whereas GMM worked better for multiple patients’ manic state detection. Both of them could help doctors and patients for better diagnosis and mood state monitoring in different situations.
Bipolar Disorder* ; Diagnosis ; Discrimination (Psychology) ; Female ; Humans ; Methods ; Smartphone ; Support Vector Machine*

OBJECTIVE: In Korea, online board games, such as “flower cards,” are played using virtual money. In contrast, Internet-based gambling (ibGambling) concerns the use of real money to gamble online. We hypothesized that online board gamers using virtual money show less risky behaviors than do gamblers who use real money, and that, in regard to psychological aspects, online board gamers are less depressed and more introverted than online gamblers are. METHODS: For this study, 100 online board gamers, 100 ibGamblers, 100 offline gamblers (offGamblers), and 100 age- and sex-matched healthy controls were recruited by an online research company. Gambling behavior and self-efficacy were assessed using the Korean Gambling Behavior Scale-high/low factors (KGBS-H/L) and the Gambling Abstinence Self-efficacy Scale (GASS). Additionally, introversion, depression, and mania tendency were assessed. RESULTS: Online board gamers had good intentions gaming, as evidenced by their higher KGBS-L scores than ibGamblers and offGamblers, and they showed less risky behaviors, as evidenced by their lower KGBS-H scores than offGamblers. Additionally, online board gamers were less introverted than ibGamblers and less depressed than offGamblers. CONCLUSION: Online board gaming could be a gateway to the world of gambling (ibGambling or OffGambling). However, the higher tendency of online board gamers to engage in good intentioned gaming could help prevent online board gaming from progressing to online or offline gambling.
Bipolar Disorder ; Depression ; Gambling ; Intention ; Introversion (Psychology) ; Korea

OBJECTIVES: The purpose of this study was to compare psychological test profiles of psychiatric outpatients with high and low depression/suicide ideation and to identify predictor variables for depression/suicide ideation. METHODS: Component scores of the Personality Assessment Inventory (PAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were compared using t-tests. Discriminant analysis was conducted for predictor variables of depression/suicide ideation. RESULTS: Regarding PAI profiles, somatic complaints (SOM), anxiety (ANX), anxiety-related disorder (ARD), depression (DEP), paranoia (PAR), borderline features (BOR), antisocial features (ANT), mania (MAN) drug problems (DRG) scores were significantly elevated in high depression and high suicide ideation groups. Concerning MMPI-2 profiles, the scores of hypochondriasis (Hs), depression (D), hysteria (Hy), psychopathic deviate (Pd), paranoia (Pa), psychasthenia (Pt), schizophrenia (Sc), social introversion (Si) were significantly elevated in these same groups. The PAI and MMPI-2 profile shapes were remarkably similar between high depression and high suicide ideation groups. Therefore, in terms of psychological profile, depression and suicidal ideation seemed to reflect the same construct. However, in discriminant analysis, significant predictors for depression were found to be Pt and D Sc from MMPI-2, while those for suicide ideation were found to be Pa and Sc, suggest subtle differences. CONCLUSION: The superficial characteristics of depression and suicide ideation groups reflected by the psychological test profiles seemed similar, but the determining factors may differ. Thus, the psychological interventions for these two groups may have to follow different routes considering these subtle differences.
Anxiety ; Bipolar Disorder ; Depression ; Discriminant Analysis ; Humans ; Hypochondriasis ; Hysteria ; Introversion (Psychology) ; Minnesota ; Outpatients ; Paranoid Disorders ; Personality Assessment ; Psychological Tests ; Schizophrenia ; Suicidal Ideation ; Suicide

OBJECTIVES: Stress can substantially affect the symptoms and courses of mood disorders. Among the various factors of stress perception, one's personality traits and mood states are especially important. The aim of the current study is to examine the influences of personality traits on perceived stress in mood disorder, comparing depressive disorders and bipolar disorders. METHODS: Patients with depressive disorders (n=81) and bipolar disorders (n=79) and who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnostic criteria were recruited. Stress perception was measured using the Perceived Stress Scale (PSS). Personality traits were assessed using the Temperament and Character Inventory and the Neo-Five Factor Inventory. Linear regression analysis was performed to examine and determine the predictors that significantly affect perceived stress. RESULTS: Results of univariate linear regression analysis showed that neuroticism, harm avoidance, and novelty seeking were positively related to the PSS score in patients with bipolar disorder. However, agreeableness, self-directedness, extraversion, cooperativeness, and conscientiousness subscales were negatively related to the PSS score. In depressive patients as well, harm avoidance and neuroticism were positively related to the PSS score. Reward dependence, extraversion, agreeableness, self-directedness, and cooperativeness were negatively related to the PSS score. In multivariate linear analysis, self-directedness and extraversion were negatively associated with the PSS score in bipolar patients. CONCLUSION: These results suggest that personality traits associated with perceived stress may differ according to the subtypes of mood disorders. In addition, consideration of the differences in personality subtypes that affect perceived stress is probably required in order to establish strategies for decreasing perceived stress in mood disorder.
Bipolar Disorder ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Extraversion (Psychology) ; Humans ; Linear Models ; Mood Disorders* ; Reward ; Temperament

We aimed to examine the potential relationship between season of birth (SOB) and clinical characteristics in Korean patients with unipolar non-psychotic major depressive disorder (MDD). Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, 891 MDD patients were divided into two groups, those born in spring/summer (n=457) and those born in autumn/winter (n=434). Measurement tools comprising the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, Scale for Suicidal Ideation, Clinical Global Impression of severity, Social and Occupation Functional Assessment Scale, WHO Quality of Life assessment instrument-abbreviated version, Alcohol Use Disorder Identification Test, and Temperament and Character Inventory were used to evaluate depression, anxiety, overall symptoms, suicidal ideation, global severity, social function, quality of life, drinking, and temperament and character, respectively. Using independent t-tests for continuous variables and χ2 tests for discrete variables, the clinical characteristics of the two groups were compared. MDD patients born in spring/summer were on average younger at onset of first depressive episode (t=2.084, p=0.038), had greater loss of concentration (χ2=4.589, p=0.032), and were more self-directed (t=2.256, p=0.025) than those born in autumn/winter. Clinically, there was a trend for the MDD patients born in spring/summer to display the contradictory characteristics of more severe clinical course and less illness burden; this may have been partly due to a paradoxical effect of the 5-HT system.
Adult ; Age of Onset ; Aged ; Alcohol Drinking ; Bipolar Disorder/*diagnosis/*ethnology/psychology ; Character ; Cost of Illness ; Depression ; Depressive Disorder, Major/*diagnosis/*ethnology/psychology ; Female ; Humans ; Male ; Middle Aged ; Personality Inventory/statistics & numerical data ; *Quality of Life ; Republic of Korea/epidemiology ; *Seasons ; Temperament

Forty patients (20 male and 20 female) diagnosed with bipolar disorder voluntarily participated in this study. For each patient, questionnaire and computerized objective data, obtained from involved doctors, nurses, psychologists, prosecutors, and the hospital information system, were collected after receiving the patients'written consent. When a patient's answers diverged greatly from computerized data (i.e., onset age, history of criminal prosecution and re-hospitalization), computerized data were given priority. Immediately after the authors collected the questionnaires, any personal identifying information was replaced by random numbers to prevent bias and protect privacy. Statistical analysis was performed using SPSS version 20.0 for MS Windows. Comparative items on questionnaires were evaluated by paired t test and chi square test. Male patients were found to have a higher recidivism rate than female patients (P<0.05). Female patients reported more trauma history (P<0.05), bipolar type II diagnoses (P<0.05), and suicide attempts (P<0.01) than male patients. There was no statistically significant difference between male and female patients for Intelligence Quotient (IQ) or for 13 of the Minnesota Multiphasic Personality Inventory (MMPI) subscales.
Age of Onset ; Bias (Epidemiology) ; Bipolar Disorder ; Criminals ; Diagnosis ; Female ; Hospital Information Systems ; Hospitals, Psychiatric* ; Humans ; Intelligence ; Male ; MMPI ; Privacy ; Psychology ; Suicide

OBJECTIVES: Stigma resistance is an individual capacity to fight the stigma of mental illness and is an issue of ongoing research regarding the stigma. The aim of this study was to evaluate predictors of stigma resistance in patients with bipolar disorder. METHODS: Demographic, clinical, and psychosocial data were collected from 102 bipolar patients in a university mental hospital. Stigma resistance was measured using a subscale of the Internalized Stigma of Mental Illness Scale. Patients completed self-reported questionnaires including items on self-esteem, hopelessness, social support, and social conflict. RESULTS: Stigma resistance showed positive association with functioning, self-esteem, and social support, and showed negative association with depressive symptoms, hopelessness, and social conflict. In multivariate analysis, stigma resistance was predicted by sex, education, and self-esteem. Self-esteem was the strongest predictive factor of stigma resistance. CONCLUSION: In accordance with previous studies, self-esteem was a central role of predicting stigma resistance. A program for improving self-esteem and its related psychosocial factors will be helpful to enhancing stigma resistance in bipolar patients.
Bipolar Disorder* ; Depression ; Education ; Hospitals, Psychiatric ; Humans ; Multivariate Analysis ; Psychology ; Self Concept

Pancreatitis is a very rare adverse effect of quetiapine treatment, with only 5 cases of quetiapine-associated pancreatitis reported in the English literature to date. Herein, we report one patient who developed severe hypertriglyceridemia (>1000 mg/dL) after quetiapine administration, resulting in acute pancreatitis. An analysis of the underlying pathogenic mechanisms and a review of relevant literature are also presented. Clinicians should be aware of the potentially life-threatening metabolic disturbances and/or pancreatitis associated with quetiapine therapy.
Acute Disease ; Bipolar Disorder/*drug therapy/*psychology ; Dibenzothiazepines/*therapeutic use ; Humans ; Hypertriglyceridemia/*drug therapy/*psychology ; Pancreatitis/*drug therapy/*psychology

OBJECTIVE: Bipolar disorder patients often show excessive goal-directed and pleasure-seeking behavior during manic episodes and reduced hedonic capacity during depressive episodes, indicating that bipolar disorder might involve altered reward processing. As such, bipolar disorder subjects have been reported to show impaired reward learning in situations requiring integration of reinforcements over time. In this study, we examined characteristics of reward learning in euthymic patients with bipolar disorder using a probabilistic reward task. METHODS: We recruited 23 euthymic patients with bipolar disorder and 47 healthy subjects for the probabilistic reward task. This task is a reward-based paradigm to produce a response bias, in which correct identifications of two ambiguous stimuli are differently rewarded. The other dependent measures were the discriminability, hit rate and reaction time. RESULTS: Relative to comparison subjects, bipolar patients showed a reduced acquisition of response bias toward the more frequently rewarded stimulus (p<0.01). The overall reward learning was positively correlated with state and trait anxiety levels in bipolar patients (p<0.01). No significant differences of discriminability, hit rates, and reaction time were found between bipolar patients and controls. CONCLUSION: These findings suggest that euthymic patients with bipolar disorder may have deficits in reward learning related to anxiety.
Anxiety ; Bias (Epidemiology) ; Bipolar Disorder ; Humans ; Learning ; Reaction Time ; Reinforcement (Psychology) ; Reward