No abstract

Introduction-Bipolar Disorder is characterized by recurrent episodes of depression and/or mania along with interepisodic mood symptoms that interfere with psychosocial functioning. Despite periods of symptomatic recovery, individuals with bipolar disorder often continue to experience impairments in psychosocial functioning, particularly occupational functioning. Two determinants of psychosocial functioning of euthymic (neither fully depressed nor manic) individuals with bipolar disorder are residual depressive symptoms and cognitive impairment (i.e. difficulties with executive functioning, attention and memory).

Objectives-Cigarette smoking in individuals with bipolar disorder has been associated with suicidal behavior, although the precise relationship between the two remains unclear.Methods-In this prospective observational study of 116 individuals with bipolar disorder, we examined the association between smoking and suicidality as measured by Linehan's Suicide Behaviors Questionnaire (SBQ) and prospective suicide attempts over a nine-month period. Impulsivity was measured by the Barratt Impulsiveness Scale.Results-Smoking was associated with higher baseline SBQ scores in univariate and adjusted analyses, but was not significant after statistical adjustment for impulsivity in a regression model. A higher proportion of smokers at baseline made a suicide attempt during the follow-up period (5/31, 16.1%) compared to nonsmokers (3/85, 3.5%); p = 0.031, odds ratio = 5.25 (95% confidence interval: 1.2-23.5). Smoking at baseline also significantly predicted higher SBQ score at nine months.Conclusions-In this study, current cigarette smoking was a predictor of current and ninemonth suicidal ideation and behavior in bipolar disorder, and it is likely that impulsivity accounts for some of this DisclosuresIn the last five years, MJO has received consulting fees/honoraria from Concordant Rater Systems, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., Forest, GlaxoSmithKline, Massachusetts General Hospital Psychiatry Academy, Janssen, and Pfizer. In the last five years, RHP has received consulting fees/honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, Pfizer, and Proteus; has received speakers fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, and Pfizer; and has been a stockholder in Concordant Rater Systems, LLC. In the past three years, AAN has received research support from Cyberonics, Cederroth, Ortho-McNeil-Janssen, Pfizer, Pam Labs, and Shire; consulted to and served on advisory boards of Abbott Laboratories, Appliance Computing, Inc., Brain Cells., Inc, Bristol-Myers Squibb, EpiQ, Pam Labs, PGX Health, Forest, Eli Lilly & Co, GlaxoSmithKline, Janssen, Jazz, Merck, Novartis, Pfizer, Schering-Plough, Sepracor, Shire, Somerset, Takeda, and Targacept; has received honoraria from the MGH Psychiatry Academy [supported in 2008 through Independent Medical Education (IME) grants from AstraZeneca, Eli Lilly & Co., and Janssen]; and has owned stock options in Appliance Computing, Inc. NMS has received research grants from AstraZeneca, Bristol-Myers Squibb, Cephalon, Forest, GlaxoSmithKline, Janssen, Eli Lilly & Co., NARSAD, NIMH, Pfizer, UCB-Pharma, and Sepracor; has served on advisory boards or provided consultation for the American Foundation for Suicide Prevention, Paramount Biosciences, Pfizer, Sepracor, and Solvay; and has served as speaker/CME presenter for AstraZeneca, Forest, MGH Psychiatry Academy, Janssen, Eli Lilly & Co., Pfizer, and UCBPharma. RTL, HGL, SJM, and GSS have no conflicts of interest related to this work. .9] and 33.4% of those with bip...

This is the first CBT-I outcome study to analyze discrepancy changes and demonstrate that these changes account for a significant portion of self-report outcome. In addition, improved sleep quality as measured by a decrease in percentage of stage N1 sleep following treatment may be one mechanism that explains why sleep estimation is more accurate following CBT-I.

Patient depression, after accounting for chronicity of symptoms, independently predicts caregiver burden. This study underscores the important impact of bipolar depression on those most closely involved with those whom it affects.