Fuente: PubMed "Cannabis" Biol Psychiatry Cogn Neurosci Neuroimaging. 2025 Dec 12:S2451-9022(25)00390-8. doi: 10.1016/j.bpsc.2025.12.002. Online ahead of print.ABSTRACTBACKGROUND: Bipolar disorder coincides with one of the highest rates of suicide out of all psychiatric conditions. Individual differences in stress reactivity may contribute to increased susceptibility to suicide-related thoughts and behaviors (STBs). Research examining stress response and relations 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 suicide attempt history.METHODS: Seventy-two young adults (22 with bipolar disorder and history of suicide attempt(s) [BD-SA], 21 diagnostic controls without suicide attempt history [BD-noSA], 29 typically developing [TD]) were assessed for past-month perceived stress (PSS) and completed a fMRI stress math task. Stress-related functional changes in anterior-paralimbic regions of interest were examined in relation to PSS. Effects of lifetime alcohol/cannabis use disorder and nicotine use on stress reactivity were explored.RESULTS: In BD-SA young adults, 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: p's<0.008). These patterns were not observed in the BD-noSA or TD groups. Lifetime CUD and recent nicotine use related to greater anterior-paralimbic responses to stress in bipolar disorder (p's<0.002).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 relations between stress reactivity, cannabis/nicotine use, and STBs.PMID:41391524 | DOI:10.1016/j.bpsc.2025.12.002