Lifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis.

Psychotic symptoms, that we defined as delusions or hallucinations, are common in bipolar disorders (BD). This systematic review and meta-analysis aims to synthesise the literature on both lifetime and point prevalence rates of psychotic symptoms across different BD subtypes, including both BD type I (BDI) and BD type II (BDII). We performed a systematic search of Medline, PsycINFO, Embase and Cochrane Library until 5 August 2021. Fifty-four studies (N = 23 461) of adults with BD met the predefined inclusion criteria for evaluating lifetime prevalence, and 24 studies (N = 6480) for evaluating point prevalence. Quality assessment and assessment of publication bias were performed. Prevalence rates were calculated using random effects meta-analysis, here expressed as percentages with a 95% confidence interval (CI). In studies of at least moderate quality, the pooled lifetime prevalence of psychotic symptoms in BDI was 63% (95% CI 57.5-68) and 22% (95% CI 14-33) in BDII. For BDI inpatients, the pooled lifetime prevalence was 71% (95% CI 61-79). There were no studies of community samples or inpatient BDII. The pooled point prevalence of psychotic symptoms in BDI was 54% (95 CI 41-67). The point prevalence was 57% (95% CI 47-66) in manic episodes and 13% (95% CI 7-23.5) in depressive episodes. There were not enough studies in BDII, BDI depression, mixed episodes and outpatient BDI. The pooled prevalence of psychotic symptoms in BDI may be higher than previously reported. More studies are needed for depressive and mixed episodes and community samples.Prospero registration number: CRD 42017052706.

Does physical ill-health increase the risk of suicide? A census-based follow-up study of over 1 million people.

AIMS: Mental ill-health is a known risk factor for suicide mortality. However, the relationship between physical ill-health and suicide is less clear. This study examined the relationship between different aspects of physical ill-health and the risk of suicide death. METHODS: Data for 1 196 364 adults (aged 18 years and over) were identified from the 2011 Northern Ireland Census and linked to death registrations until the end of 2015. Multivariate logistic regression was used to construct models to test associations with likelihood ratio tests for interactions. RESULTS: Over one in eight individuals (13.7%) reported multimorbidity (⩾2 physical health conditions) and one in four (25.4%) identified having limitation of daily activities. During follow-up, 51 672 individuals died; 877 due to suicide. The gradient in suicide risk by number of physical conditions disappeared following adjustment for activity limitation. Individuals with a lot of activity limitation were over three times more likely to die by suicide (OR = 3.13, 95% CI 2.50-3.93) compared to those with no limitations though this was reduced to OR = 1.72 (95% CI 1.35-2.20) with adjustment for poor mental health. The relationship between activity limitation and suicide was most pronounced at younger ages (18-34 years). CONCLUSIONS: This study suggests that it is the effect that physical illness has on a person's life, in terms of disruption to daily activity, rather than the number of conditions that predicts suicide risk, especially at younger ages. Improved awareness and better management of mental wellbeing of individuals with physical health conditions may help to reduce suicides, especially in younger people.

Experiences from polio supplementary immunization activities in Anambra State, Nigeria.

BACKGROUND: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio-free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization. MATERIALS AND METHODS: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions. RESULTS: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State's cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero-dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV 3 ) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV 3 target. CONCLUSION: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.