Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders

Background

Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders.

Objective

The aim of the study was to look for suicide risk factors among sociodemographic and clinical factors, family history and stressful life events in patients with diagnosis of unipolar and bipolar affective disorder (597 patients, 563 controls).

Method

In the study, the Structured Clinical Interview for DSM-IV Axis I Disorders and the Operational Criteria Diagnostic Checklist questionnaires, a questionnaire of family history, and a questionnaire of personality disorders and life events were used.

Results

In the bipolar and unipolar affective disorders sample, we observed an association between suicidal attempts and the following: family history of psychiatric disorders, affective disorders and psychoactive substance abuse/dependence; inappropriate guilt in depression; chronic insomnia and early onset of unipolar disorder. The risk of suicide attempt differs in separate age brackets (it is greater in patients under 45 years old). No difference in family history of suicide and suicide attempts; marital status; offspring; living with family; psychotic symptoms and irritability; and coexistence of personality disorder, anxiety disorder or substance abuse/dependence with affective disorder was observed in the groups of patients with and without suicide attempt in lifetime history.     

Rivastigmine reduces "likely to use methamphetamine" in methamphetamine-dependent volunteers

Purpose

To study the prevalence of metabolic syndrome in patients with bipolar disorder.

Material and method

By using purposive random sampling 200 patients with bipolar disorder receiving treatment were evaluated for presence of metabolic syndrome using International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

Results

Eighty patients fulfilled IDF criteria and 82 patients met NCEP ATP-III criteria for metabolic syndrome. There was significant concordance between these two criteria sets for metabolic syndrome (Kappa value 0.979, p < 0.015). Among the individual parameters studied — increased waist circumference (70.1%) was the most common abnormality, followed by increased blood pressure (44.5%) and increased triglycerides levels (42%). Compared to patients without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and higher percentage of them (74.4% vs 51.7%) were more than 35 years of age. Logistic regression analysis revealed that these two variables significantly predicted metabolic syndrome.

Conclusion

Findings of the present study suggest that abdominal obesity is the most common abnormality and metabolic syndrome is best predicted in patients with bipolar disorder by higher age and higher body mass index.     

Prevalence and clinical correlates of alcohol use disorders among bipolar disorder patients: Results from the Brazilian Bipolar Research Network

Objectives

To investigate prevalence rates and clinical correlates of alcohol use disorders (AUD) among bipolar disorder (BD) patients in a large sample from the Brazilian Bipolar Research Network.

Methods

Four hundred and eighty-three DSM-IV BD patients, divided according to the presence or absence of a lifetime AUD diagnosis (BD-AUD vs. BD-nonAUD), were included. Demographic and clinical characteristics of these two groups were compared. Logistic regression was performed to identify which characteristics were most strongly associated with a lifetime AUD diagnosis.

Results

Nearly 23% presented a lifetime AUD diagnosis. BD-AUD patients were more likely to be male, to present rapid cycling, post-traumatic stress disorder (PTSD), anorexia, other substance use disorders (SUD), family history of SUD, any substance misuse during the first mood episode, history of psychosis, suicide attempts, and younger age at onset of illness than BD-nonAUD patients. Logistic regression showed that the variables most strongly associated with a lifetime AUD diagnosis were SUD (non-alcohol), any substance misuse during the first mood episode, PTSD, male gender, suicide attempt, family history of SUD, and younger age at onset of BD.

Conclusions

BD-AUD patients begin their mood disorder earlier and present more suicidal behaviors than BD-nonAUD patients. Personal and family history of SUD may be good predictors of comorbid AUD among BD patients. These variables are easily assessed in the clinical setting and may help to identify a particularly severe subgroup of BD patients.     

Brain GABA levels in patients with bipolar disorder

Purpose

A growing body of research supports an important role for GABA in the pathophysiology of bipolar and other mood disorders. The purpose of the current study was to directly examine brain GABA levels in a clinical sample of bipolar patients.

General methods

We used magnetic resonance spectroscopy (MRS) to examine whole brain and regional GABA, glutamate and glutamine in 13 patients with bipolar disorder compared to a matched group of 11 healthy controls.

Findings

There were no significant differences in GABA, glutamate or glutamine between patients and controls.

Conclusions

Further research is needed to better characterize the GABAergic and glutamatergic effects of pharmacotherapy, anxiety comorbidity and clinical state in bipolar disorder.     

Hopelessness and suicidal risk in bipolar disorder. A study in clinically nonsyndromal patients

Objective

Attempted suicide and death due to suicide are not uncommon among patients with bipolar disorder. Although some risk factors for suicidality in bipolar patients have been identified, little is known about hopelessness and other possible trait or diathesis-related factors. Consequently, the objective of this study was to investigate variables associated with suicidal risk in clinically nonsyndromal bipolar patients.

Methods

A sample of 102 outpatients with a diagnosis of bipolar disorder according to International Classification of Diseases, 10th Revision criteria during nonsyndromal stage were evaluated. On the basis of suicidal history, patients were divided into suicide attempt, suicidal ideation, and nonsuicidal groups. Sociodemographic, clinical, and psychopathological variables were assessed.

Results

As compared with the nonsuicidal group, female sex, combined psychopharmacologic treatment, and hopelessness were independently associated with suicide attempt. Hopelessness and insight into having a mental disorder were independently associated with history of suicidal ideation.

Conclusions

Patients with bipolar disorder and suicidal history are characterized by the presence of hopelessness, which probably confers greater vulnerability for suicidal behavior in the presence of stress factors. This identification of the risk profile for suicidal behavior in nonsyndromal bipolar patients adds complementary information to risk factors established for suicidality during acute phases of the disease, allows for differentiated preventive and treatment approaches of patients at risk, and suggests psychotherapy as an advisable intervention in this group of patients.     

Relationship between inflammation and metabolic syndrome following treatment with paliperidone for schizophrenia

Objective

Metabolic syndrome and antipsychotic medications are associated with inflammation. This study investigated the relationship between inflammation and metabolic syndrome in patients with schizophrenia. It also examined the effects of paliperidone extended release (ER) treatment on metabolic parameters.

Methods

Data were analyzed from schizophrenic patients who participated in a multi-center, open-label, non-comparative clinical trial. Anthropomorphic measurements (i.e., weight, waist circumference, and blood pressure) were assessed along with fasting laboratory values, including white blood cell (WBC) count, glucose, high-density lipoprotein, and triglycerides.

Results

Among the 225 patients at baseline, the group with the highest WBC count displayed a 5.9-fold risk for metabolic syndrome compared with that of the lowest group. An increase of 10³ WBCs/μL was associated with a 1.4-fold increased risk for metabolic syndrome. After 24 weeks of treatment with paliperidone ER, significant increases were observed in waist circumference and body weight. Changes in WBC count were positively correlated with changes in waist circumference.

Conclusions

Schizophrenic patients with high levels of inflammation should be carefully monitored for metabolic syndrome. Moreover, strategies to reduce inflammation and obesity may prevent metabolic syndrome in patients with schizophrenia who take atypical antipsychotic medication.     

Temperament and character traits in patients with bipolar disorder and associations with attempted suicide

Objective

This study was intended to investigate temperament and character traits in bipolar disorder patients with or without a history of attempted suicide.

Methods

One hundred nineteen patients diagnosed with euthymic bipolar disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and with no accompanying Axis I and II comorbidity, and 103 healthy controls were included. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II disorders were used to exclude Axis I and II comorbidity. Temperament and character traits of bipolar patients with a history attempted suicide (25.2%, n = 30) or without (74.8%, n = 89) and of the healthy volunteers were determined using the Temperament and Character Inventory. The association between current suicide ideation and temperament and character traits was also examined.

Results

Bipolar patients with or without a history of attempted suicide had higher harm avoidance (HA) scores compared with the healthy controls. Persistence scores of bipolar patients with no history of attempted suicide were lower than those of the healthy controls. Self-directedness (SD) scores of the bipolar patients with a history of attempted suicide were lower than those of patients with no such history. Self-transcendence scores of bipolar patients with no history of attempted suicide were lower than those of both the healthy controls and of those patients with a history of attempted suicide. A positive correlation was determined between current suicidal ideation scale scores and HA, and a negative correlation between SD and cooperativeness was determined.

Conclusions

High harm avoidance may be a temperament trait specific to bipolar disorder patients. However, it may not be correlated with attempted suicide in such patients. These may have low persistence, high SD and low self-transcendence temperament and character traits that protect against attempted suicide. Harm avoidance, SD, and cooperativeness may be correlated with current suicidal ideation.     

Correlates of psychiatric hospitalization in a clinical sample of Canadian adolescents with bipolar disorder

Objective

To identify factors associated with psychiatric hospitalization among adolescents with bipolar disorder (BD).

Methods

Participants were 100 adolescents, ages 13–19, who fulfilled DSM-IV criteria for bipolar I disorder [(BD-I), n = 26], bipolar II disorder [(BD-II), n = 40], or operationalized criteria for BD not otherwise specified [(BD-NOS), n = 34], via the Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version (KSADS-PL). Demographic, clinical, and family history variables were measured via clinical interview with the participant and a parent or guardian.

Results

The lifetime prevalence of psychiatric hospitalization was 50%. Significant predictors of psychiatric hospitalization in univariate analyses included older age, BD-I, history of suicide attempt, psychosis, lifetime use of second generation antipsychotics (SGAs), lithium, SSRI antidepressants and any medication. BD-II was negatively associated with psychiatric hospitalization. In multivariable analyses, older age, history of suicide attempt, psychosis and use of SGAs were positively associated with hospitalization, whereas BD-II was negatively associated with hospitalization.

Conclusions

Psychiatric hospitalization in adolescents with BD is highly prevalent and associated with older age and proxies for greater illness severity. Further studies are needed to identify strategies for reducing the need for psychiatric hospitalizations among adolescents with BD.     

The metabolic syndrome and related characteristics in major depression: inpatients and outpatients compared: Metabolic differences across treatment settings

Objective

We aimed to systematically compare patients with major depressive disorder from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and related metabolic variables.

Method

The outpatient samples were drawn from the ongoing Netherlands Study of Depression and Anxiety (302 primary care and 445 secondary care outpatients). The inpatient sample (n=80) was recruited from five Dutch mental health hospitals. The assessments of MetSyn and related variables [waist circumference (WC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), waist–hip ratio (WHR), LDL and total cholesterol (TC)] were compared using analysis of (co)variance and regression analysis, whereas medication analyses examined the extent to which clinical differences (e.g., depression severity or medication use) mediated the observed metabolic differences across setting.

Results

MetSyn prevalences (26% primary, 24% secondary care and 28% inpatients) did not significantly differ (P=.71). WC, BMI, LDL cholesterol, glucose and DBP were not significantly different across settings. However, WHR, TC and triglyceride levels were higher in inpatients than in both outpatients groups, while HDL cholesterol levels and SBP were lower. There was some mediating role for tricyclic and non-selective serotonin-reuptake inhibitor antidepressant use, but overall, the mediating role of clinical differences was limited.

Conclusions

Although overall MetSyn prevalences did not differ, patterns of individual MetSyn-related variables differed more markedly across depressed inpatients and outpatients. Inpatients showed more adverse WHR and serum lipid profiles, while SBP levels were lower.     

Lack of association between cerebral microbleeds and low serum cholesterol in patients with acute intracerebral hemorrhage

Background

The association of cerebral microbleeds (CMBs) with intracerebral hemorrhage (ICH) is well known and its relationship with low serum cholesterol in ICH patients might be of interest.

Methods

A total of 105 patients with ICH were evaluated. In all subjects cholesterol levels were measured after 12 h of fasting and gradient-echo magnetic resonance imaging (GE-MRI) was performed for detecting CMBs.

Results

CMBs were more common among patients with hypertension and leukoaraiosis (p = 0.008 and p = 0.001). Patients with and without CMBs did not differ according to total cholesterol, LDL cholesterol, triglycerides and HDL cholesterol levels.

Conclusion

In this study, 61% of Turkish ICH patients had CMBs, which was not associated with lipid profiles. Leukoaraiosis was independently associated with CMBs.     

Prevalence and Risk Factors Associated with Suicide Ideation and Attempts in Korean College Students

Objective

Suicide is a leading cause of death in college age students. Identification of the associated risk factors has important implications for how to prevent and respond to this population; however, few studies have been performed on this topic in this age group. The purpose of this study was to evaluate the prevalence and risk factors associated with suicide ideation and attempts in college students.

Methods

Three hundred sixty-eight college students participated in this cross-sectional observational study. The recent (over two weeks) suicide ideation and lifetime suicide attempts were defined according to Moscicki''s suicide behavior index. Sociodemographic variables were assessed and psychopathology measured using the Beck Depression Inventory, the Bipolar Spectrum Diagnostic Scale and the Alcohol Use Disorders Identification Test. A hierarchical multiple logistic regression analysis was used to identify the significant risk factors related to suicide ideation and attempts.

Results

The two-week prevalence of suicidal ideation was 9.8%, and the lifetime prevalence of suicide attempts was 3.3%. The univariate analysis showed that students who had more severe depression (p<0.001), a higher probability for bipolar disorder (p<0.001) and decrement of academic achievement (p<0.005) were more likely to have suicide ideation. Those with factors such as severe depression (p<0.05), a higher probability of bipolar disorder (p<0.001), a low socioeconomic status (p<0.001), who lived alone (p<0.01), and were female (p<0.05) had a higher risk for suicide attempts. The most important predictors of suicide ideation, by the logistic regression analysis, were depression, probability for bipolar disorder and academic achievement, and the risks identified for suicide attempts were socioeconomic status and probability of bipolar disorder.

Conclusion

Suicide ideation and attempts were common in college students. The results of this study suggest that early identification and management of mood disorders and other sociodemographic risk factors may have implications for intervention and prevention.     

Low anxiety disorder comorbidity rate in bipolar disorders in Han Chinese in Taiwan

Objectives

Studies report high comorbidity of lifetime anxiety disorders with bipolar disorders in Western patients, but it is unclear in Taiwan. The authors explored the comorbidity of anxiety disorders in different bipolar disorder subtypes in Han Chinese in Taiwan.

Methods

Three hundred twenty-five patients with bipolar disorder (bipolar I: 120; bipolar II: 205) disorder were recruited from two general medical outpatient services. They were evaluated and their diagnoses confirmed by a psychiatrist using the Chinese version of the Modified Schedule of Affective Disorder and Schizophrenia-Lifetime. The exclusion criteria were: any DSM-IV-TR Axis I diagnosis, other than bipolar disorder, being outside the 18-65-year-old age range, any other major and minor mental illnesses except anxiety disorder, any neurological disorders or organic mental disorders.

Results

Thirty-two (26.7%) of patients were comorbid with lifetime anxiety disorder and bipolar I, 80 (39.0%) with lifetime anxiety disorder and bipolar II, 7 (5.8%) were comorbid with two or more anxiety disorders and bipolar I, and 27 (13.2%) with two or more anxiety disorders and bipolar II.

Conclusion

That more than twice as many bipolar II than bipolar I patients reported two or more anxiety disorders implies that the complication is more prevalent in bipolar II patients.     

Suicide attempts and mortality in eating disorders: a follow-up study of eating disorder patients

Objective

The aim of this study is to explore the prevalence of hospital-treated suicide attempts in a large clinical population of eating disorder patients.

Method

Follow-up study of adults (N= 2462, 95% women, age 18–62 years) admitted to the Eating Disorder Clinic of Helsinki University Central Hospital in the period 1995–2010. For each patient, four controls were selected and matched for age, sex and place of residence. The end point events were modeled using Cox’s proportional hazard model, taking matching into account.

Results

We identified 156 patients with eating disorder (6.3%) and 139 controls (1.4%) who had required hospital treatment for attempted suicide. Of them, 66 (42.3%) and 37 (26.6%) had more than one attempt. The rate ratio (RR) for suicide attempt in patients with eating disorder was 4.70 [95% confidence interval (CI) 1.41–15.74]. In anorexia nervosa, RR was 8.01 (95% CI 5.40–11.87), and in bulimia nervosa, it was 5.08 (95% CI 3.46–7.42). In eating disorder patients with a history of suicide attempt, the risk of death from any cause was 12.8%, suicide being the main cause in 45% of the deaths.

Conclusion

Suicide attempts and repeated attempts are common among patients with eating disorders. Suicidal ideation should be routinely assessed from patients with eating disorders.     

Temperament and character personality profile in relation to suicide attempts in patients with schizophrenia

Introduction

Schizophrenia is associated with a significant risk of suicide, and suicide still remains one of the main causes of death in schizophrenic patients. Beside classic risk factors for suicidality, temperament and character traits have been researched and considered as risk factors for suicidal behavior in recent years.

Method

Subjects were 94 patients with schizophrenia who were under treatment. All patients were in a stable phase of the illness. Patients with lifetime suicide attempt (n = 46) and without suicidal attempt (n = 48) were compared with each other in terms of temperament and character traits by using the Temperament and Character Inventory.

Results

Harm avoidance and persistence scores were higher in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. The scores of self-directedness and cooperativeness were lower in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. These 4 variables remained significant predictors of lifetime suicidal attempts in a logistic regression model.

Conclusion

To the best of our knowledge, the present study is the first that specifically compares schizophrenic patients with and without suicidal behavior by the Cloninger temperament and character model. Our data indicate that schizophrenic patients will show a greater risk for suicide according to certain personality configurations. However, to establish causal relationships between personality and suicidality in schizophrenia, longitudinal studies are warranted within a multifactorial interactive framework of biologic and clinical variables.     

Sex differences in biopsychosocial correlates of binge eating disorder: a study of treatment-seeking obese adults in primary care setting

Objective

Although community-based studies suggest equivalent levels of physical and psychological impairment by binge eating disorder (BED) in men and women, men with BED are still underrepresented in clinical studies. This study aimed to provide a comprehensive analysis of sex differences in biopsychosocial correlates of treatment-seeking obese patients with BED in primary care.

Method

One hundred-ninety obese adults (26% men) were recruited in primary care settings for a treatment study for obesity and BED.

Results

Very few significant sex differences were found in the developmental history and in current levels of eating disorder features, as well as psychosocial factors. Women reported significantly earlier age at onset of overweight and dieting and greater frequency of dieting. Men reported more frequent strenuous exercise. Men were more likely than women to meet criteria for metabolic syndrome; men were more likely to show clinically elevated levels of triglycerides, blood pressure, and fasting glucose levels.

Conclusion

Despite few sex differences in behavioral and psychosocial factors, metabolic problems associated with obesity were more common among treatment-seeking obese men with BED than women. The findings highlight the importance of including men in clinical studies of BED and active screening of BED in obese men at primary care settings.     

SCN8A as a novel candidate gene associated with bipolar disorder in the Han Chinese population

Background

Bipolar disorder (BPD) is a common, severe and recurrent psychiatric disorder. It has been suggested that BPD patients have a higher risk of suicide than patients with any other psychiatric illnesses. A recent study found that suicide attempt was associated with the SCN8A gene, which has been mapped close to one of the BPD susceptibility loci. Thus, SCN8A is likely to be a candidate gene for BPD.

Methods

In this study, three SNPs (rs1601012, rs303810, rs60637) were analyzed in 506 bipolar patients and 507 controls of Han origin.

Results

We found that two individual SNPs showed statistically significant differences between cases and controls in both allele and genotype distribution, but only rs303810 was still significant in allele distribution (p = 0.0164) after correction. No obvious linkage disequilibrium or haplotypes were observed among these SNPs.

Conclusion

Our results indicate that SCN8A may be a potential susceptibility gene for bipolar disorder in the Han Chinese population.     

Predictors of suicide in patients with conversion disorder

Objective

Previous studies have shown that the ratio of suicide attempts is between 19.6 and 34.2% in patients with conversion disorder (CD), yet few studies have addressed this issue. The present study compared demographic and clinical variables and predictors of suicide attempts in patients with CD.

Methods

A total of 100 consecutive patients were recruited and divided into groups according to their history of suicide attempts. Socio-demographic variables such as economic status, age, gender, educational level, marital status, clinical variables such as the presence of psychiatric disorder in family, substance abuse, risky alcohol use, age of onset, subtype of CD, number of hospitalization were recorded. Participants also completed the Childhood Trauma Questionnaire (CTQ-28), Temperament and Character Inventory (TCI), Toronto Alexithymia Scale (TAS-20), Dissociative Experiences Scale (DES), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI).

Results

Suicide attempters had a higher rate of risky alcohol use, more hospitalizations, and higher mean scores on the BAI, BDI, DES/DES-taxon, TAS-total and CTQ-total than did non-suicide attempters or healthy control (NHC). Patients with CD had a higher harm-avoidance and a lower self-directedness rather than NHC. Risky alcohol use, number of hospitalizations, and mean DES-taxon and emotional abuse scores were independent predictors of suicide attempts.

Conclusion

Our findings indicate that clinicians should be aware of the prediction of suicide in patients with CD who show dissociation and risky alcohol use. Moreover, a history of childhood emotional abuse should be considered in the management of CD. The fact that clinical variables distinguished between suicide attempters and non-attempters suggests that a history of suicide attempts may be used to clarify the heterogeneous nature of CD.     

A Sib-Pair analysis of impulsivity in bipolar disorder type I

Objective

The aim of this study was to compare impulsivity among patients with bipolar disorder, their siblings, and healthy controls in order to examine whether impulsivity in bipolar disorder is related to genetic liability for the illness.

Methods

Using the Barratt Impulsiveness Scale, we assessed 204 subjects: 67 euthymic outpatients with bipolar disorder type I, 67 siblings without bipolar disorder, and 70 healthy controls.

Results

Impulsivity scores were higher among patients with bipolar disorder than among healthy controls. Siblings showed higher motor impulsivity scores than did healthy controls.

Conclusions

Our results suggest that motor impulsivity may be a vulnerability marker for bipolar disorder. Our data may contribute to further improve preventive strategies in subjects at high risk for bipolar disorder.     

Self-image and suicide in a Swedish national eating disorders clinical register

Objective

Using a prospective design, to examine the relation between self-image (assessed using the Structural Analysis of Social Behavior) and suicide attempts/completions in women with anorexia nervosa-restricting type (ANR), anorexia nervosa-binge/purge type (ANBP), bulimia nervosa (BN), binge eating disorder (BED), and eating disorder not otherwise specified (EDNOS); and to assess whether these self-image variables add unique predictive value to suicide when considering other baseline predictors.

Method

Women (N = 2269) aged 12 to 45 (M = 22.1) presenting to specialist eating disorders clinics in Sweden between 2005 and 2009 were identified through the Stepwise Eating Disorders Quality Register. Data on age, body mass index, eating disorder severity (Eating Disorder Examination-Questionnaire scores), psychiatric comorbidity, global assessment of functioning, and self-image were abstracted from Stepwise and included as baseline predictors or covariates. Suicide information (prior attempt and attempt/completion after Stepwise registration) was obtained from the National Patient Register and Cause of Death Register.

Results

Prevalence of detected suicide attempts/completions over the study period was 9.2%. Negative self-image variables were associated with prior suicide attempts in ANR and EDNOS and later suicide attempts/completions in women with BN. In a stepwise Cox proportional hazards model, only low self-affirmation predicted time to suicide attempts/completions in women with BN when accounting for age and prior suicide attempt.

Conclusion

Assessing self-image might assist with identifying women with BN at elevated risk for suicide.     

Clinically significant hoarding in obsessive-compulsive disorder: results from an Indian study

Background

Hoarding is frequently conceptualized as a symptom of obsessive-compulsive disorder (OCD), but recent evidence indicates that, in most cases, hoarding may be better conceptualized as a distinct disorder that can coexist with OCD. Most of the research on hoarding is from the Western countries. This study aimed to provide data on the prevalence and correlates of clinically significant hoarding in a large sample of patients with OCD from the Indian subcontinent.

Methods

We examined 200 patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition OCD for clinically significant hoarding using the Saving Inventory–Revised, followed by a clinical interview.

Results

Twenty patients (10%) had clinically significant hoarding. In all cases, hoarding did not appear to be related or secondary to other OCD symptoms. None of the cases consulted for their hoarding problems. Compared with nonhoarders, hoarders hailed exclusively from an urban background and had a significantly higher frequency of certain obsessions and compulsions, bipolar disorder, generalized anxiety disorder, cluster C personality disorders, and a higher number of lifetime suicidal attempts. They also had a more severe OCD along with poorer global functioning and somewhat poorer insight into obsessive-compulsive symptoms.

Conclusions

The results suggest that clinically significant hoarding is relatively prevalent in Indian patients with OCD and that it appears to be largely unrelated to the OCD phenotype. However, the presence of comorbid hoarding is associated with more severe OCD, high comorbidity, more suicidal attempts, and a lower level of functioning. The results contribute to the current nosologic debate around hoarding disorder and provide a unique transcultural perspective.