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Abstract 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.

Abstract 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

Background: This retrospective analysis examined the effects of left-sided dorsolateral prefrontal cortex (DLPFC) repetitive transcranial magnetic stimulation (rTMS) on comorbid anxiety symptoms patients with treatment resistant depression (TRD). Method: Response rates, remission rates, reliable change index (RCI), and clinically significant change (CSC) were assessed using the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 17-item Hamilton Rating Scale for Depression (HAMD-17) Anxiety subscale at over an average of 32.9 treatments (SD ​= ​9.2). Results: Fifty-seven TRD patients showed statistically and clinically significant improvement in all anxiety measurements with left DLPFC rTMS. Limitations: This retrospective study had no sham control and allowed for medication changes during the rTMS treatment course. Conclusion: Left DLPFC rTMS may be an important tool in reducing anxiety in TRD patients, improving overall treatment resistant symptoms and suicide risk.

Context: Patients with mental health needs are often treated by primary care providers (PCPs). Little is known about current PCP attitudes and comfort level with mental health disorders and treatments despite their role in managing these illnesses., Objective: To quantify PCP comfort with the management of psychiatric disorders and treatments., Methods: PCPs in 2 community clinics were given a survey of psychiatric disorders, treatments, and perceived benefit of assistance from a mental health professional (data were collected during provider meetings in May 2017 and February 2021). Questions were ranked using a Likert scale from 1 to 5 with 1 being "least comfortable," 3 being "neutral," and 5 being "very comfortable." Survey responses about medications and disorders were averaged (ie, mean values were calculated) to approximate PCP comfort with providing psychiatric care with and without support., Results: A total of 71 surveys were sent, and 54 were completed. Overall, respondents indicated comfort greater than neutral in 4 of the 14 disorder-related questions (ie, for anxiety disorders, unipolar depression, attention-deficit/hyperactivity disorder [ADHD], and sleep disorders) and 7 of the 19 treatment-related questions (ie, for selective serotonin reuptake inhibitors [SSRIs]/serotonin-norepinephrine reuptake inhibitors [SNRIs], second-generation antipsychotics, other sleep medications, other antidepressants, stimulants, non-stimulant treatments for ADHD, and tricyclics). SSRIs/SNRIs were the only item with average comfort greater than 4. Mean overall PCP comfort was 2.73 without support. PCP comfort increased significantly with support from a therapist (3.24) or a psychiatrist (4.11) ( P  < .001), with backup from a psychiatrist providing significantly more comfort than a therapist ( P  < .001)., Discussion: These data show ongoing low comfort levels of PCPs in treating psychiatric conditions, suggesting a need for ongoing educational and collaborative approaches to address this critical unmet need., (© Copyright 2022 Physicians Postgraduate Press, Inc.)