Bipolar disorder (BD) is a heritable mental illness with complex etiology. We performed a genome-wide association study (GWAS) of 41,917 BD cases and 371,549 controls, which identified 64 associated genomic loci. BD risk alleles were enriched in genes in synaptic and calcium signaling pathways and brain-expressed genes, particularly those with high specificity of expression in neurons of the prefrontal cortex and hippocampus. Significant signal enrichment was found in genes encoding targets of antipsychotics, calcium channel blockers and antiepileptics. Integrating eQTL data implicated 15 genes robustly linked to BD via gene expression, including druggable genes such as HTR6, MCHR1, DCLK3 and FURIN. This GWAS provides the best-powered BD polygenic scores to date, when applied in both European and diverse ancestry samples. Together, these results advance our understanding of the biological etiology of BD, identify novel therapeutic leads and prioritize genes for functional follow-up studies.

Coercive measures are frequently used in psychiatric hospitalization. However, there are few studies that analyse perceived coercion, post‐traumatic stress, and subjective satisfaction with the hospitalization treatment associated with different types of coercive measures. The sample consisted of 111 patients admitted to two psychiatric units and divided into three groups based on the measure applied: involuntary medication (N = 41), mechanical restraint (N = 32), and combined measures (mechanical restraint and involuntary medication; N = 38). The outcome variables were perceived coercion evaluated with the Coercion Experience Scale (CES), post‐traumatic stress evaluated with the Davidson Trauma Scale (DTS), and satisfaction with the treatment evaluated with the Client's Assessment of Treatment (CAT). The results found higher levels of perceived coercion associated with the use of mechanical restraint (P = 0.002) and combined measures (P < 0.001) in comparison with involuntary medication. Additionally, in relation to post‐traumatic stress, mechanical restraint (P = 0.013) and combined measures (P = 0.004) were more stressful compared to involuntary medication. Finally, the use of combined measures was associated with lower satisfaction with inpatient psychiatric treatment compared to the use of involuntary medication (P = 0.006). The following recommendation would be consistent with the results found: if a patient does not specify a preference for some type of measure, involuntary medication could be used and mechanical restraint avoided, especially when used in combination with involuntary medication.

Objective: This study aims to analyse the number and characteristics of calls made to the Málaga Prehospital Emergency Service (PES) for suicidal behavior based on sociodemographic, temporal, and health care variables.Method: This is a retrospective, descriptive study that records all calls made to the PES due to suicidal behavior (suicide attempts and completed suicides) in 2014. Sociodemographic variables (age, sex, and health district), variables related to the calls (time-slot, degree of sunlight, type of day, month, season of the year, prioritization, and number of resources mobilized) were extracted from these calls. The number of cases and percentages were presented for the qualitative variables. The rates per 100,000 were calculated by sex and health district and presented with the corresponding 95% confidence interval (CI).Results: Of the total valid calls to PES (n = 181,824), 1,728 calls were made due to suicidal behavior (0.9%). The mean age was 43.21 (±18) years, 57.4% were women, and the rate was 112.1 per 100,000 inhabitants. The calls due to suicidal behavior were in the younger-middle age segment, in the time-slot between 16 and 23 h and during daylight hours, on bank holidays, in spring and summer in comparison with winter, and with a peak of calls in August. The majority of these calls were classified as undelayable emergencies and mobilized one health resource.Conclusions: Prehospital emergency services are the first contact to the sanitary services of persons or families with suicide attempts. This information should be a priority to offer a complete overview of the suicide behavior.

Specific plans are required, including different interventions, in order to achieve marked reduction in the use of coercive measures.

IntroductionIn recent years, there has been a significant increase in the demand for prehospital emergency care in different countries.