Recent Stress Potentiation and Paralimbic System Reactivity in Young Adults With Bipolar Disorder: Implications for Suicide Risk and Effects of Cannabis Use Disorder.

BACKGROUND

Bipolar disorder coincides with one of the highest rates of suicide among all psychiatric conditions. Individual differences in stress reactivity may contribute to increased susceptibility to suicide-related thoughts and behaviors (STBs). Research examining the stress response and its relationship with STBs in bipolar disorder is limited. The purpose of this study was to investigate associations between recent perceived stress and neurophysiological response to acute psychosocial stress in anterior-paralimbic system in young adults with bipolar disorder with and without a suicide attempt history.

METHODS

Seventy-two young adults (21 with bipolar disorder and a history of suicide attempt(s) [BD-SA], 22 diagnostic control participants without a suicide attempt history [BD-noSA], and 29 typically developing [TD] individuals) were assessed for past-month perceived stress (Perceived Stress Scale [PSS]) and completed a functional magnetic resonance imaging Stress Math Task. Stress-related functional changes in anterior-paralimbic regions of interest were examined in relation to PSS scores. Effects of lifetime alcohol/cannabis use disorder and nicotine use on stress reactivity were explored.

RESULTS

In the BD-SA group, recent perceived stress was associated with greater reactivity to psychosocial stress in the medial orbitofrontal cortex, anterior insula, amygdala, and anterior cingulate cortex (group-by-PSS interactions: ps ≤ .008). These patterns were not observed in the BD-noSA or TD groups. Lifetime cannabis use disorder and recent nicotine use were related to greater anterior-paralimbic responses to stress in bipolar disorder (ps ≤ .002).

CONCLUSIONS

Heightened anterior-paralimbic reactivity to cumulative stress may represent a risk factor for STBs. Cannabis and nicotine use may exacerbate stress-related anterior-paralimbic dysregulation. Future longitudinal research is needed to extend findings and investigate temporal relationships between stress reactivity, cannabis/nicotine use, and STBs.