title: Illness-course modulates suicidality-related prefrontal gray matter reduction in women with bipolar disorder.
abstract: OBJECTIVE
  Explore interrelationships between suicide attempt history (Objective 1) or suicide attempt severity (Objective 2) with prefrontal cortex gray matter (PFCGM ) volume and illness-course in patients with bipolar disorder (BD).
  
  
  METHODS
  Ninety-three women with BD-I or -II diagnosis (51 with and 42 without suicide attempt history) underwent structural MRI and filled out questionnaires. Measured were GM volumes of 11 PFC regions, BD illness-course, and attempt history and severity. Effects were examined with repeated measures GLM or logit analyses.
  
  
  RESULTS
  Objective 1: Attempt history was associated with increased trait impulsivity and aggression, and higher prevalence of BD-I, past drug use disorder, and past psychiatric hospitalization. PFCGM volume was lower in patients with than without attempt history in those with past psychiatric hospitalization. PFCGM volume was higher in patients with than without attempt history in those without hospitalization. Higher trait aggression predicted attempt history. Objective 2: Increased frontal pole volume and younger age at first hospitalization predicted many suicide attempts.
  
  
  CONCLUSIONS
  Attempt history in patients with BD related to PFCGM volume reduction or increase. Volume modulation by psychiatric hospitalization could reflect effects of illness-course or care. Attempt severity was not related to volume reduction. Research on suicidality-brain relationships should include illness-course and attempt severity measures.
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Lijffijt
authors.forename: E D
authors.initials: ED
authors.lastname: Rourke
authors.forename: A C
authors.initials: AC
authors.lastname: Swann
authors.forename: G B
authors.initials: GB
authors.lastname: Zunta-Soares
authors.forename: J C
authors.initials: JC
authors.lastname: Soares
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D001714:Bipolar Disorder / Q000473:pathology* / Q000523:psychology*; D001931:Brain Mapping / Q000379:methods; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D066128:Gray Matter; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007175:Impulsive Behavior; D008279:Magnetic Resonance Imaging / Q000379:methods; D009929:Organ Size; D017397:Prefrontal Cortex / Q000473:pathology*; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013781:Texas / Q000453:epidemiology
keywords: aggression; attempted; impulsivity; mood disorder; substance-related disorders; suicide