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Objective: Bipolar disorder is associated with high risk for suicidal behavior that often develops in adolescence and young adulthood. Elucidation of involved neural systems is critical for prevention. This study of adolescents and young adults with bipolar disorder with and without a history of suicide attempts combines structural, diffusion tensor, and functional MR imaging methods to investigate implicated abnormalities in the morphology and structural and functional connectivity within frontolimbic systems., Method: The study had 26 participants with bipolar disorder who had a prior suicide attempt (the attempter group) and 42 participants with bipolar disorder without a suicide attempt (the nonattempter group). Regional gray matter volume, white matter integrity, and functional connectivity during processing of emotional stimuli were compared between groups, and differences were explored for relationships between imaging modalities and associations with suicide-related symptoms and behaviors., Results: Compared with the nonattempter group, the attempter group showed significant reductions in gray matter volume in the orbitofrontal cortex, hippocampus, and cerebellum; white matter integrity in the uncinate fasciculus, ventral frontal, and right cerebellum regions; and amygdala functional connectivity to the left ventral and right rostral prefrontal cortex. In exploratory analyses, among attempters, there was a significant negative correlation between right rostral prefrontal connectivity and suicidal ideation and between left ventral prefrontal connectivity and attempt lethality., Conclusions: Adolescent and young adult suicide attempters with bipolar disorder demonstrate less gray matter volume and decreased structural and functional connectivity in a ventral frontolimbic neural system subserving emotion regulation. Among attempters, reductions in amygdala-prefrontal functional connectivity may be associated with severity of suicidal ideation and attempt lethality.

The value of utilizing objective monitoring systems incorporating operationalized signs and symptoms of hypothesized mental health concerns in individuals with developmental disabilities is now well accepted by interdisciplinary teams supporting these individuals. This article articulates in detail the establishment and implementation of of an objective monitoring system to track cyclic changes in mood in individuals with developmental disabilities and bipolar disorder. Implementation of this system creates the opportunity for care-providers, individuals with developmental disabilities and/or their substitute consent-providers to make informed decisions regarding treatment decisions to optimize quality of life in individuals affected by this complex illness. [ABSTRACT FROM AUTHOR]

Focuses on the assessment and treatment of rapid cycling bipolar disorder in individuals with developmental disabilities in Ontario. Establishment of monitoring system to ensure validity of diagnostic hypothesis; Comparison on the average age at onset and at diagnosis between rapid and nonrapid cycling groups; Evidence of hyperthyroidism in the rapid cycling type.