Correlates of suicidal ideation in dysphoric mania (original) (raw)
Related papers
Suicidality in patients with pure and depressive mania
American Journal of Psychiatry, 1994
A previous comprehensive literature review indicated that suicide accounted for 1 8.9% ofthe deaths of9,389 individuals with manic-depressive illness. The literature associates these deaths with the depressed phase ofthe disease. This study was designed to determine the rate and severity ofsuicidality among patients with pure and depressive mania. Method: The patients were 93 persons who met the Research Diagnostic Criteria (RDC) for bipolar I disorder (N=75) or schizoaffective disorder (N=1 8). All met the RDC for primary mania and the DSM-III-R criteria for bipolar disorder, manic or mixed. Patients with depressive mania met the RDC for mania and major depressive disorder concurrently. Severity ofcurrent suicidality was measured by using the Schedule for Affective Disorders and Schizophrenia suicide subscale. Differences in the mean suicidality scores between any two groups were assessed with the Kruskal-Wallis test. Relationships of age, gender, type of affective illness (bipolar I versus schizoaffective disorder), psychosis, race, and mania subtype to suicidality were assessed by using multivariate logistic regression analysis. Results: One (2.0%) ofthe 49 patients with pure mania was suicidal. In contrast, 24 (54.5%) of the 44 patients with depressive mania were suicidal. This difference was highly significant. Gender and psychosis were not related to suicidality. African-Americans were less likely to be suicidal than Caucasians. Subtype of mania had the strongest relationship to suicidality. Conclusions: A subgroup ofmanic patients are severely suicidal. Presentation in the manic state is an indication for careful assessment of depressive symptoms and suicidality.
Neuropsychiatric Disease and Treatment
Purpose: Patients with a bipolar I disorder (BD-I) manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria for "with mixed features" have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA) symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study. Patients and methods: Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 "with mixed features" specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts. Results: Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6%) met the criteria for the DSM-5 "with mixed features" specifier (three or more depressive symptoms). These patients were further stratified according to the severity of their AIA symptoms: "mild AIA" (zero or one AIA symptom above a severity threshold; 105 patients) or "severe AIA" (all three AIA symptoms above a severity threshold; 167 patients). A greater incidence of suicidal ideation was observed in the severe AIA group (71.9%) than in the mild AIA group (47.6%). Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P,0.05) and over the patient's lifetime (1.56 vs 1.04 attempts, respectively). Conclusion: The high risk of suicide among BD-I mania patients with depressive symptoms is further increased when they experience severe AIA symptoms. Recognizing AIA symptoms in BD-I mania could provide a means of identifying patients with depressive symptoms, as well as those who may be suicidal, thereby allowing for appropriate, tailored treatment.
Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters
Journal of Affective Disorders, 2000
Objective: Bipolar Disorder is associated with a higher frequency of attempted suicide than most other psychiatric disorders. The reasons are unknown. This study compared bipolar subjects with a history of a suicide attempt to those without such a history, assessing suicidal behavior qualitatively and quantitatively, and examining possible demographic, psychopathologic and familial risk factors. Methods: Patients (ages 18 to 75) with a DSM III-R Bipolar Disorder (n 5 44) diagnosis determined by a structured interview for Axis I disorders were enrolled. Acute psychopathology, hopelessness, protective factors, and traits of aggression and impulsivity were measured. The number, method and degree of medical damage was assessed for suicide attempts, life-time. Results: Bipolar suicide attempters had more life-time episodes of major depression, and twice as many were in a current depressive or mixed episode, compared to bipolar nonattempters. Attempters reported more suicidal ideation immediately prior to admission, and fewer reasons for living even when the most recent suicide attempt preceded the index hospitalization by more than six months. Attempters had more lifetime aggression and were more likely to be male. However, attempters did not differ from nonattempters on lifetime impulsivity. Limitations: The generalizability of the results is limited because this is a study of inpatients with a history of suicide attempts. Patients with Bipolar I and NOS Disorders were pooled and a larger sample is needed to look at differences. We could not assess psychopathology immediately prior to the suicide attempt because, only half of the suicide attempters had made attempts in the six months prior to admission. Patients with current comorbid substance abuse were excluded. No suicide completers were studied. Conclusions: Bipolar subjects with a history of suicide attempt experience more episodes of depression, and react to them by having severe suicidal ideation. Their diathesis for acting on feelings of anger or suicidal ideation is suggested by a higher level of lifetime aggression and a pattern of repeated suicide attempts.
Suicidal behaviour during different phases of bipolar disorder
Journal of Affective Disorders, 2007
Background: There are no previous studies comparing the prevalence and risk factors for suicidal behaviour during different phases of bipolar disorder. Methods: In the Jorvi Bipolar Study (JoBS), 1630 psychiatric in-and outpatients were screened for bipolar disorders with the Mood Disorder Questionnaire. Using SCID I and II interviews, 191 patients were diagnosed with bipolar disorders (90 bipolar I, 101 bipolar II). Suicidal ideation was measured using the Scale for Suicidal Ideation (SSI). Prevalence and risk factors for ideation and attempts during different phases (depressive, mixed, depressive mixed and hypomanic/manic phases) were investigated. Results: There were marked differences between phases regarding suicide attempts and level of suicidal ideation. Hopelessness predicted suicidal behaviour during the depressive phase, whereas a subjective rating of severity of depression and younger age predicted suicide attempts during mixed phases. Limitations: The relatively small sample size in some phases. Conclusions: Suicidal behaviour varied markedly between different phases of BD. Suicide attempts and suicidal ideation were related to phases which are associated with depressive aspects of the illness. Hopelessness and severity of depression were key indicators of risk in all phases.
Suicidality, panic disorder and psychosis in bipolar depression, depressive-mania and pure-mania
Psychiatry Research, 1997
This study was undertaken to assess links between suicidality, panic disorder, psychosis, bipolar depression, depressive-mania and pure-mania. The subjects are a consecutive series of 129 persons with bipolar disorder who were admitted to a university teaching hospital; 53 had bipolar depression, 32 had depressive-mania and 44 had pure-mania. They met the Research Diagnostic Criteria (RDC) for major depressive disorder (bipolar depression), primary mania (pure-mania) or both disorders (depressive-mania) at entry into the study. Suicidality, intra-episode panic disorder (IEPD) and psychotic features were ascertained using structured interviews. Sources of data included a routine clinical interview, serial clinical assessments, the Schedule for Affective Disorders and Schizophrenia @ADS), the Structured Clinical Interview for DSM-III-R and reviews of charts. Multivariate logistic regression analysis was used to determine the strength of the relationships between suicidality, IEPD, psychotic features and the phase of illness. The rates of suicidality (79.3%, 56.3% and 2.3%), IEPD (62.3%, 62.5% and 2.3%) and psychotic features (52.8%, 96.9% and 88.6%) differed significantly between the groups with bipolar depression, depressive-mania and pure-mania. Subjects with bipolar depression and depressive-mania resembled one another with respect to the severity, but not rate of suicidal&y. They had identical rates of IEPD. Subjects with bipolar depression had a higher probability of being suicidal and a lower probability of being psychotic than persons with either subtype of mania. Pure-mania was distinguished by low rates of suicidal@ and IEPD. The authors describe directions for prospective studies of the relationships between phase of illness and phenomena in groups of bipolar persons.
Suicide Attempts in Bipolar Patients
The Journal of Clinical Psychiatry, 2001
Background: Between 25% to 50% of patients with bipolar disorder make suicide attempts during their lives, but there are some controversies about factors related to suicide attempts in this group of patients. The aim of this study is to investigate the association between suicide attempts and the predictive factors previously described in the literature.
Lifetime rhythmicity and mania as correlates of suicidal ideation and attempts in mood disorders
Comprehensive Psychiatry, 2006
Background: The aim of this study is to establish to what degree variation in lifetime experience of rhythmicity and manic-hypomanic features correlates with suicidality in individuals with mood disorders and other major psychiatric diagnoses and in a comparison group of controls. Method: Suicidal ideation and attempts were investigated in a clinical sample, including 77 patients with schizophrenia, 60 with borderline personality disorder, 61 with bipolar disorder, 88 with unipolar depression, and 57 with panic disorder, and in a comparison group of 102 controls. Using information derived from the diagnostic interview and a self-report assessment of mood spectrum symptoms, subjects were assigned to 3 categories according to the maximum level of suicidality achieved in the lifetime (none, ideation/plans, and suicide attempts). The association of categorical and continuous variables with suicidality levels was investigated using multinomial logistic regression models. Results: Suicidal ideation and plans were more common in unipolar depression (50%) and bipolar disorder (42.4%) than in borderline personality disorder (30%), whereas the reverse was true for suicidal attempts. In each of the study groups, the number and the type of mood spectrum items endorsed, including depressive and manic-hypomanic items and rhythmicity and vegetative symptoms, were associated with increased levels of suicidality. Conclusions: Our results suggest that the assessment of lifetime rhythmicity and manic-hypomanic features may be clinically useful to identify potential suicide attempters in high-risk groups. D
Suicide attempts and clinical features of bipolar patients
Saudi Medical Journal, 2016
Objectives: To identify clinical predictors of suicide attempts in patients with bipolar disorder. Methods: This study included bipolar patients who were treated in the Psychiatry Department, Haseki Training and Research Hospital, Istanbul, Turkey, between 2013 and 2014; an informed consent was obtained from the participants. Two hundred and eighteen bipolar patients were assessed by using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis-I (SCID-I) in order to detect all possible psychiatric comorbid diagnoses. Clinical predictors of suicide attempts were examined in attempters and nonattempters. The study design was retrospective. Results: The lifetime suicide attempt rate for the entire sample was 19.2%. Suicide attempters with bipolar disorder had more lifetime comorbidity of eating disorder. Female gender and family history of mood disorder were significant predictors for suicide attempts. There was no difference between groups in terms of bipolar disorder subtype, onset age of bipolar disorder, total number of episodes, first and predominant episode type, suicide history in first degree relatives, severity of episodes, and hospitalization and being psychotic. Conclusion: Our study revealed that female gender, family history of mood disorder, and eating disorder are more frequent in bipolar patients with at least one suicide attempt.
Suicide attempts in bipolar disorder patients
Object: The risk of completed suicide is very high among bipolar disorder (BPD) patients. The risk of attempted suicide is not as well-quantified, but attempting suicide is the most important factor for predicting the risk of subsequent completed suicide.