Background Structural brain abnormalities have been demonstrated in subjects with BPD in prefrontal and fronto-limbic regions involved in the regulation of emotion and impulsive behavior, executive cognitive function and episodic memory. Impairment in these cognitive functions is associated with increased vulnerability to suicidal behavior. We compared BPD suicide attempters and non-attempters, high and low lethality attempters to healthy controls to identify neural circuits associated with suicidal behavior in BPD. Methods Structural MRI scans were obtained on 68 BPD subjects (16 male, 52 female), defined by IPDE and DIB/R criteria, and 52 healthy controls (HC: 28 male, 24 female). Groups were compared by diagnosis, attempt status, and attempt lethality. ROIs were defined for areas reported to have structural or metabolic abnormalities in BPD, and included: mid-inf. orbitofrontal cortex, mid-sup temporal cortex, anterior cingulate, insula, hippocampus, amygdala, fusiform, lingual and parahippocampal gyri. Data were analyzed using optimized voxel-based morphometry implemented with DARTEL in SPM5, co-varied for age and gender, corrected for cluster extent (p<.001). Results Compared to HC, BPD attempters had significantly diminished gray matter concentrations in 8 of 9 ROIs, non-attempters in 5 of 9 ROIs. Within the BPD sample, attempters had diminished gray matter in Lt. insula compared to non-attempters. High lethality attempters had significant decreases in Rt. mid-sup. temporal gyrus, Rt. mid-inf. orbitofrontal gyrus, Rt. insular cortex, Lt. fusiform gyrus, Lt. lingual gyrus and Rt. parahippocampal gyrus compared to low lethality attempters. Conclusions Specific structural abnormalities discriminate BPD attempters from non-attempters and high from low lethality attempters.

The present study examines the effectiveness of psych-astrotherapy on pathological gamblers.75-Pre-treated and 75Post-treated pathological gamblers were evaluated at S. I. Mental and Physical Health Society (SIMPHS) Varanasi district in India. These groups were matched on age (range 19 to 44years with a mean age of 29.6 years and they had gambled for an average of 12.5 years with a mean length of uncontrollable gambling of 9.7 years). Indian adaptation of T.A.T. (Seven cards) 1, 3B, 4, 6BM, 7BM, 13MF was used to ascertain personality characteristics on the four selected dimensions viz: need, press, interpersonal relations and outcome. Mean scores obtained on different variables were analyzed using t-test of significance. Results indicated that the characteristics associated with Post- treated pathological gamblers were cognizance, dominance, autonomy, achievement, counteraction, affiliation, sex capacity, interpersonal relations and outcome whereas the characteristics associated with Pre-treated pathological gamblers were aggression, rejection, passivity, acquisition, and press.

Study ObjectiveThe population of patients with major depressive disorder (MDD) and suicidal ideation (SI) or behaviors/attempts (SA) is not well characterized. Electronic health records (EHR) may contain useful data elements that are unavailable in other routinely used population-level databases like insurance claims. For example, the Patient Health Questionnaire (PHQ)-9 is a disease severity metric in this population which may influence treatment choices and hence, outcomes. This study sought to describe the treatments, depression severity, and health resource utilization among this population prior to, during, and following a suicide-related event.MethodsAdult patients enrolled in an integrated delivery network with a diagnosis code indicating MDD and without a diagnosis for bipolar or related disorders, dementia, intellectual disability, schizophrenia or other non-mood psychotic disorders between 10/31/2015 and 9/30/2019 were selected from the Optum de-identified EHR database. Only patients with a diagnosis code for SI or probable SA (SI/SA) between 10/31/2016 and 9/3/2019 and healthcare activity ≥12 months prior to their 1st observed SI/SA diagnosis were included. MDD-related treatments and PHQ-9 scores (obtained from physician notes using natural language processing) were described during 3 periods: the 1st SI/SA health care encounter (index period), 12 months before (pre-period), and 6 months after (follow-up period). For those with multiple PHQ-9 scores during a period, the latest one was used. All-cause and MDD-related healthcare utilization were assessed during follow-up period.ResultsA total of 71,161 patients with MDD and SI/SA were included in the analysis; mean (SD) age was 39 years (16 years); 55% were female. Antidepressants were prescribed for 31.3% during the pre-period and 41.2% during the index period. The use of psychotherapy was 9.5% during the pre-period and 18.7% during the index period. In the subgroup with data at 6 months (N=40,261), 43.4% and 20.5% received an antidepressant prescription and psychotherapy, respectively. During follow-up, the percent with ≥1 all-cause (MDD-related) hospitalization, observation stay and ED visit were: 11.8% (7.0%), 5.0% (2.1%), and 33.1% (11.1%). More than half (61.0) had ≥1 outpatient visit, and about 1/3 (33.4%) had ≥1 MDD-related outpatient visit. Very few patients had PHQ-9 scores recorded: pre-period 4.4% (mean [SD] 13.0 [7.5]); index period 1.3% (mean [SD] 17.0 [7.2]); and follow-up period 7.6% (mean [SD] 12.1 [7.5]).ConclusionsThis study documents a high level of health care resource utilization among those with MDD and suicidal thoughts and behaviors. Only a small proportion had documented PHQ-9 scores. Given that sizable proportions did not receive any antidepressant therapy or psychotherapy, even after suicidality was noted in their medical record, continued efforts in screening and treatment intensification are warranted for this vulnerable population.FundingJanssen Scientific Affairs, LLC