A. Lengvenyte, France
Presenter of 4 Presentations
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S0014 - Suicidal Behaviour and Addiction: An Inseparable Couple? Mechanisms Underlying the Association and Targets for Interventions
, ABSTRACT
Abstract Body
Suicidal behaviour is common in people with substance use disorder or behavioural addictions, and vice versa. Suicidal behaviour and addiction share many risk factors, such as increased allostatic load, and are associated with dysregulations of reward processing and impaired prefrontal cortex functioning, resulting in decision-making problems, loss of cognitive control, and impulsivity. Trait impulsivity predisposes the individual to increased sensitization to stressors or addictive stimuli. Addiction emerges when the motive for a pleasurable substance or activity transitions from positive to negative reinforcement. At this point, the stress response system is activated, and the main motivator shifts from pleasure to the escape from an aversive stimulus –withdrawal and craving. In parallel, insufferable psychological pain is the core component of the suicidal process, and a suicide attempt has been conceptualized as a way to reduce or escape it. Both states are associated with increased pain perception, stress system activation, inflammation, and anhedonia. However, while addiction generally reflects a shift from pleasure to the avoidance of negative stimuli, the pleasure is less identifiable in the suicidal process. Furthermore, not all individuals that engage in suicidal behaviours are impulsive or have an addiction, and not all individuals with addiction engage in suicidal behaviours. Yet, the understanding of the shared neurobiological component of addiction and suicidal behaviours may inform possible interventions in some individuals. Reward, pain, and stress systems are possible targets. Promising substances related to these systems that could reduce suicide risk include buprenorphine, lithium, ketamine, and psychological interventions aimed at psychological pain reduction and resilience.
S0092 - Risk Factors for Suicidal Behaviours in Late-onset Bipolar Disorder
ABSTRACT
Abstract Body
Late-onset bipolar disorder (BD), when symptoms emerge after the age of 50 years, has gained recognition in the past decades. Currently, BD of about one in ten older patients is considered to be late-onset. Since suicide risk is extremely elevated in BD, especially at the onset of the illness, patients that live to old age are generally considered a survivor population. Meanwhile, patients with late-onset BD did not have BD while living through life periods that could be associated with typical risk factors for suicidal behaviours. Moreover, the late-onset BD might have specific etiopathogenesis, as demonstrated by less genetic component and more life stressors, medical comorbidity and alcohol use. Clinically, patients with late-onset BD have more depressive episodes and more favourable treatment outcomes, yet clinicians generally fail to adhere to guidelines while treating these patients. In n=614 older age BD patients from FondationFondamental Expert Centers, late-onset BD patients reported less lifetime suicidal ideation and attempts compared to non-late-onset patients, while there was no difference regarding the last year suicidal ideation. Better verbal memory was associated with more suicidal behaviour reporting in both groups. Meanwhile, late-onset patients had lower affect intensity and less childhood trauma – factors that were strongly positively associated with last year suicidal ideation in patients with earlier, but not late-onset BD. Meanwhile, late-onset BD patients had higher arterial blood pressure, which was associated with lifetime suicide attempt history in them, but not in earlier-onset patients. Late-onset BD seems to have a distinct pathway to suicidal behaviours.