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Objective: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. Method: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. Results: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59% of the patients have suicide ideation and 25-56% present at least one suicide attempt during lifetime. Approximately 15% to 19% of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis land Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. Conclusion: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior. [ABSTRACT FROM AUTHOR]

An editorial is presented on the negative early life experiences as risk factors for suicidal behavior in bipolar disorders. Topics include the suicidal behavior has influenced by several factors, and understanding the diathesis together with the precipitating factors that trigger the behavior being fundamental.

The article reports on an open label pilot study of 8 treatment for resistant depression patients. Topics discussed include effectivness of ketamine drug for the management of depression patients; an account of dissociative symptoms associated with the same such as lightheadedness, and infusion experience among the patients who were treated with the same.

The article focuses on the challenges of the new editors of the Brazilian psychiatric journal "Revisita Brasileira de Psiquiatria" (RBP). According to the editors, their goal is to maintain the growth rate of RBP and to work hard to further improve the excellence of the journal. The editors cite their plan to use online management of articles to accelerate the process of reviewing articles. The editors also mention that they will have the value of their impact factor in 2008.

Objectives: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. Methods: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). Results: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. Conclusions: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population. [ABSTRACT FROM AUTHOR]

The article focuses on the rise in the impact factor of the periodical "Revista Brasileira de Psiquiatria (BRP) by 1.225 in 2007 to 1.318 in 2008, according to news issued by the Institute of Scientific Information (ISI) Web of Knowledge. It states the plan of the periodical to reform the online management system of the editorial process by shifting to ScholarOne Manuscript process. The authors express hope that such developments will encourage Brazilian and Latin American researchers to submit their studies and peer reviews to RBP.

Objectives: To examine the composition of self-regulation in pediatric bipolar disorder (PBD) through the relationship between executive functions, emotion processing, and family environmental factors. Methods: 58 participants (36 with PBD and 22 controls), ages 12-17, were assessed using the Barratt Impulsiveness Scale (BIS), Conners' Continuous Performance Test (CPT-II), Wisconsin Cards Sorting Test (WCST), Computerized Neurocognitive Battery Emotion Recognition Test-Facial Emotion Recognition Test (PENNCNB ER-40), and Expressed Emotion Adjective Checklist Questionnaire (EEAC). Results: Adolescents with PBD displayed significant deficits in all three spheres when compared to the control group. Emotion processing correlated negatively with inhibition and attention, and correlated positively with mental flexibility/working memory. Family environmental factors correlated negatively with mental flexibility/working memory and emotion processing, and positively with attention and inhibition. These correlations indicate that better inhibitory control, attention, and mental flexibility/working memory are associated with greater emotion processing and a fitter family environment. Conclusion: This study is the first to investigate all of the components of self-regulation deficits simultaneously in patients with PBD. Results suggest that self-regulation is essential for a comprehensive perspective of PBD and should be assessed in an integrative and multifaceted way. Understanding that self-regulation is impacted by the abovementioned factors should influence treatment and improve the functional impairments of daily life observed in this population. [ABSTRACT FROM AUTHOR]

Individuals with bipolar disorder are at substantial risk for high rates of comorbidity with cardiovascular risk factors. Cardiovascular disease has been recognized as the leading cause of death in this population. This paper summarizes the evidence on the association between cardiovascular mortality and bipolar disorder, as well as recommendations for the prevention and management of hypertension, dyslipidemia, diabetes, obesity, metabolic syndrome, and smoking as part of the treatment of bipolar disorder. [ABSTRACT FROM AUTHOR]

Social cognition has gained prominence in psychiatric research, beginning with schizophrenia and more recently in bipolar disorder. Considering the relevance of this domain to interpersonal relationships and functionality, we aimed to explore the fundamental research and clinical issues regarding social cognition and discuss future directions and challenges in the field of bipolar disorder. [ABSTRACT FROM AUTHOR]

Objective: Depression is a frequent, recurrent and chronic condition with high levels of functional disability. Brazilian Medical Association Guidelines project proposed guidelines for diagnosis and treatment of the most common medical disorders. The objective of this paper is to present a revision of the Guidelines Published in 2003 incorporating new evidences and recommendations. Method: This review was based on guidelines developed in other countries and systematic reviews, randomized clinical trials and when absent, observational studies and recommendations from experts. Brazilian Medical Association proposed this methodology for the whole project. The revision was developed from new international guidelines published since 2003. Results: The following aspects are presented: prevalence, demographics, disability, diagnostics and sub-diagnosis, efficacy of pharmacological and psychotherapeutic treatment, costs and side-effects of different classes of available drugs in Brazil. Strategies for different phases of treatment are also discussed. Conclusion: Guidelines are an important tool for clinical decisions and a reference for orientation based on levels of evidence in the literature. [ABSTRACT FROM AUTHOR]

Objective: To compare social skills and related executive functions among bipolar disorder (BD) patients with a family history of mood disorders (FHMD), BD patients with no FHMD and healthy control (HCs). Methods: We evaluated 20 euthymic patients with FHMD, 17 euthymic patients without FHMD, and 31 HCs using the Social Skills Inventory (SSI) and a neuropsychological battery evaluating executive function, inhibitory control, verbal fluency and estimated intelligence. Results: Both BD groups had lower SSI scores than controls. Scores for one subfactor of the social skills questionnaire, conversational skills and social performance, were significantly lower among patients with FHMD than among patients without FHMD (p = 0.019). Both groups of BD patients exhibited significant deficits in initiation/inhibition, but only bD patients with FHMD had deficits in verbal fluency, both compared to HC. There were no associations between social skills questionnaire scores and measures of cognitive function. Conclusion: Euthymic BD patients have lower social skills and executive function performance than HC. The presence of FHMD among BD patients is specifically associated with deficits in conversational and social performance skills, in addition to deficits in verbal fluency. Both characteristics might be associated with a common genetically determined pathophysiological substrate. [ABSTRACT FROM AUTHOR]

The article offers a strategy to regulate the emotion of children and adolescent during the COVID-19 pandemic. Topics mentioned include the key objective of acceptance and commitment therapy to achieve value-oriented life, some exercises offered by dialectical behavior therapy, and the important skills needed by children and adolescents for social-emotional learning.

Objective: Rapid cycling (RC) is a feature of bipolar disorder (BD) that has been associated with worse outcome and more severe disability. Our goal was to investigate the association of demographic and clinical factors with RC. Methods: We compared RC and non-rapid cycling (NRC) BD patients from the Brazilian Research Network in Bipolar Disorder (BRN-BD) regarding age at onset of BD; total number of episodes; previous number of manic, depressive, mixed, and hypomanic episodes; polarity of the first episode; gender; number of suicide attempts; number of lifetime hospitalizations and lifetime history of at least one hospitalization; family history of mood disorder; clinical comorbidities such as hypothyroidism, hyperthyroidism, seizures; and current use of medications such as lithium, anticonvulsants, antipsychotics, and antidepressants. Results: We studied 577 patients and found that 100 (17.3%) met the criteria for RC in the year before the investigation. RC patients had earlier age at onset, longer duration of disease, more lifetime depressive and manic episodes, higher number of suicide attempts, and higher rate antidepressant use. Conclusion: The presence of RC in the previous year was associated with specific clinical characteristics closely related to worse outcome in the course of BD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Unaffected relatives of bipolar disorder (BD) patients have been investigated for the identification of endophenotypes in an attempt to further elucidate the pathophysiology of the disease. Brain-derived neurotrophic factor (BDNF) is considered to be implicated in the pathophysiology of BD, but its role as an endophenotype has been poorly studied. We investigated abnormal serum BDNF levels in BD patients, in their unaffected relatives, and in healthy controls. METHODS: BDNF levels were obtained from 25 DSM-IV bipolar I disorder patients, 23 unaffected relatives, and 27 healthy controls. All BD patients were in remission. The unaffected subjects were first-degree relatives of the proband who had no lifetime DSM-IV diagnosis of axis I disorder. BDNF serum levels were determined by sandwich ELISA using monoclonal BDNF-specific antibodies. RESULTS: There were no statistical differences in BDNF levels among BD patients, relatives, and healthy controls. CONCLUSION: Serum BDNF levels may not indicate high genetic risk for BD, possibly acting as state markers rather than trait markers of the disease. [ABSTRACT FROM AUTHOR]

Objective: Bipolar disorder (BD) is associated with significant morbidity and mortality due to comorbid general medical conditions, particularly cardiovascular disease. This study is the first report of the Brazilian Research Network in Bipolar Disorder (BRN-BD) that aims to evaluate the prevalence and clinical correlates of cardiovascular risk factors among Brazilian patients with BD. Methods: A cross-sectional study of 159 patients with DSM-IV BD, 18 years or older, consecutively recruited from the Bipolar Research Program (PROMAN) in São Paulo and the Bipolar Disorder Program (PROTAHBI) in Porto Alegre. Clinical, demographic, anthropometric, and metabolic variables were systematically assessed. Results: High rates of smoking (27%), physical inactivity (64.9%), alcohol use disorders (20.8%), elevated fasting glucose (26.4%), diabetes (13.2%), hypertension (38.4%), hypertriglyceridemia (25.8%), low HDL-cholesterol (27.7%), general (38.4%) and abdominal obesity (59.1%) were found in the sample. Male patients were more likely to have alcohol use disorders, diabetes, and hypertriglyceridemia, whereas female patients showed higher prevalence of abdominal obesity. Variables such as medication use pattern, alcohol use disorder, and physical activity were associated with selected cardiovascular risk factors in the multivariable analysis. Conclusion: This report of the BRN-BD provides new data regarding prevalence rates and associated cardiovascular risk factors in Brazilian outpatients with BD. There is a need for increasing both awareness and recognition about metabolic and cardiovascular diseases in this patient population. [ABSTRACT FROM AUTHOR]

The article focuses on the change in the editorial board of the periodical "Revista Brasileira de Psiquiatria" (RBP) in 2008. Doctor Luis Augusto Rohde has decided to remain as an editor to help with the transition and to avoid discontinuity. It is the aim of the new editorial board to be able to keep the constant growth and modernization of RBP in an effort to accomplish its mission of disclosing the best clinical information. Also noted is the goal of the editors to remain in the same route established for RBP by the former board.

Objective: Literature review of the controlled studies in the last 18 years in emotion recognition deficits in bipolar disorder. Method: A bibliographical research of controlled studies with samples larger than 10 participants from 1990 to June 2008 was completed in Medline, Lilacs, PubMed and ISI. Thirty-two papers were evaluated. Results: Euthymic bipolar disorder presented impairment in recognizing disgust and fear. Manic BD showed difficult to recognize fearful and sad faces. Pediatric bipolar disorder patients and children at risk presented impairment in theft capacity to recognize emotions in adults and children faces. Bipolar disorder patients were more accurate in recognizing facial emotions than schizophrenic patients. Discussion: Bipolar disorder patients present impaired recognition of disgust, fear and sadness that can be partially attributed to mood-state. In mania, they have difficult to recognize fear and disgust. Bipolar disorder patients were more accurate in recognizing emotions than depressive and schizophrenic patients. Bipolar disorder children present a tendency to misjudge extreme facial expressions as being moderate or mild in intensity. Conclusion: Affective and cognitive deficits in bipolar disorder vary according to the mood states. Follow-up studies re-testing bipolar disorder patients after recovery are needed in order to investigate if these abnormalities reflect a state or trait marker and can be considered an endophenotype. Future studies should aim at standardizing task and designs. [ABSTRACT FROM AUTHOR]

Objective: Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. Method: Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. Results: Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. Conclusion: In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies. [ABSTRACT FROM AUTHOR]

The authors reflect on the editorial quality of the periodical "Revista Brasileira de Psiquiatria" (RBP) which achieved the highest impact factor among health scientific journals in Latin America. They note that the Institute of Scientific Information gave RBP an impact factor rate of 1.225 in 2007. They add that the high impact factor achieved by RBP reflects improvement in quality, its investment in Brazilian research and graduate programs. They claim that the scientific improvement and independence of RBP encourage researchers to submit their works.

A letter is presented that reported the results of a study that evaluated social skills in bipolar patients with a previous history of suicide attempts. Study subjects were evaluated using the Brazilian Social Skills Inventory. Findings showed that patients with a history of suicide attempts have lower IHS scores that assessed conversational skills and social self-confidence, among others.

A reply by Andrew Alan Nierenbeg to a letter to the editor about his article "Antidepressant Treatment-Emergent Switch in Bipolar Disorder: A Prospective Case-Control Study of Outcome" in a 2006 issue is presented.