Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. Conclusion A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.
Background and aim: Psychiatric disorders and antidepressant usage rates have increased over the years. However, prejudice, self, and public stigma continue to impede patients from receiving appropriate treatment, especially in traditional societies. In this study, the views of first and sixth-year medical students were examined. We aimed to show the potential effect of public information and 6 years of medical education on knowledge and awareness. Method: Our target population was first and sixth-year medical students at the Faculty of Medicine at Hacettepe University in Ankara, Turkey, during the semester 2018–2019. For measurement, widely used scales such as the Beck Depression Inventory, Beck Anxiety Inventory were administered. In addition, scales formed specifically by our research team: Sociodemographic information form and Depression and Antidepressant Awareness and Knowledge Scale were used. Results: Compared to first-year participants, sixth-year participants had significantly less stigmatizing views on individual statements. The overall stigma score of sixth-year participants was significantly lower ( p < .05) than first-year participants. Linear Regression Analysis showed that the only predictor of overall stigma score was the depression score ( p < .05, beta = −0.36), which acted as a negative predictor. Discussion: Sixth-year participants had higher rates of diagnosed psychiatric illness and psychiatric drug usage. Interestingly, the score was not a predictor of the overall stigma score. However, in the responses to individual statements, we observed an overall increase in knowledge and decreased stigma among the sixth-year participants compared to first-year participants. The effects of medical education on knowledge are significant overall. On the other hand, the level of knowledge and beliefs of our first-year participants, which are similar to the public, show a worrisome situation indicating that broader public education efforts are needed. Our study shows an encouraging perspective, indicating that public awareness campaigns can be very effective in increasing knowledge and decreasing misconceptions.
Background Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample. Methods Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001. Results The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger. Conclusion UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition.
Objective: To evaluate the mental health of patients with schizophrenia spectrum disorders with the prolongation of the pandemic. Materials and Methods: This descriptive cross-sectional study was conducted between August-October 2020. Fifty-two patients with schizophrenia spectrum disorders who were hospitalized prior to the onset of the pandemic between March 2019-March 2020 at the inpatient clinic were reassessed during the pandemic. The Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression-Severity (CGI-S) Scale, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) and Fear of COVID-19 Scale were used to evaluate psychopathology during the pandemic. The PANSS and the CGI severity scores at discharge from the inpatient clinic for each patient were obtained from the medical records review for comparison along with sociodemographic variables.Results: A total of 34 patients, 33 with schizophrenia (97.1%) and 1 with schizoaffective disorder (2.9%) were included. There was no significant difference between the pre- and during the pandemic assessments in the PANSS total and the CGI severity scores. The PANSS total, the CGI, HAM-D, HAM-A and the Fear of COVID-19 scale scores, medical comorbidity and utilization of psychiatric health care services were significantly higher in patients who reported subjectively increased psychiatric symptoms during the pandemic. There was no significant difference in the change of PANSS total and CGI scores between the two groups. Fear of COVID-19 Scale and HAM-A scores were correlated positively. Conclusion: During pandemic increase in psychiatric symptoms may be related not only to psychosis but also depression, anxiety. According to the results of patients who reported subjectively increased psychiatric symptoms during the pandemic, while the psychotic symptoms did not worsen during the pandemic, patients with higher anxiety or depression scores reported an increase in their symptoms and were more likely to seek help.
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