Suicidal behavior in bipolar mood disorder: Clinical characteristic of attempters and non-attempters

MHCRC for the Study of Suicidal Behavior and the Stanley Foundation Center for Applied Neuroscience of Bipolar Disorders, Department of Neuroscience, New York State Psychiatric Institute, Columbia University, NY 10032, USA.
Journal of Affective Disorders (Impact Factor: 3.38). 09/2000; 59(2):107-17. DOI: 10.1016/S0165-0327(99)00129-9
Source: PubMed


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.
Patients (ages 18 to 75) with a DSM III-R Bipolar Disorder (n = 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.
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.
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.
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.

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Available from: Kevin M Malone, Oct 10, 2015
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    • "Previous research has shown the occurrence of SAs in patients suff ering from BPD to be associated with a family history of attempted suicides (Roy 1993; Linkowski et al. 1985), an association also found in the present study. As regards educational level, patients in our sample with lower academic achievement were at increased-risk SAs, which also accords with previously published fi ndings (Oquendo et al. 2000; Malone et al. 1995), although the underlying mechanism remains unclear. It is possible that early onset of psychiatric disorders (Paus et al. 2008) adversely aff ects higher school performance. "
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    ABSTRACT: Objectives: To assess the relationship between lifetime suicide attempts (SAs), serum lipid values, and metabolic syndrome (MetS) in patients with bipolar disorders (BPD). Methods: Eighty patients with BPD took part in the study (M = 40.60 years). After psychiatric diagnosis, demographic data, SAs, and serum lipids were measured and MetS was calculated. Results: 70% reported at least one suicide attempt. 52.5% suffered from MetS. Suicide attempters had higher cholesterol values. SAs were associated with a family history of suicide, current mood state, and lower educational level. SAs were unrelated to MetS. Conclusions: In patients with BPD, against expectations, the occurrence of SAs was associated with higher cholesterol values. Serum lipid values are not suitable as a biological trait marker to predict SAs.
    International Journal of Psychiatry in Clinical Practice 11/2014; 19(2). DOI:10.3109/13651501.2014.988271 · 1.39 Impact Factor
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    27th ECNP Congress, Berlin, Germany; 10/2014
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    • "Mental Health and Well-Being survey estimated the lifetime prevalence rate for BPD in Canada at 2.2%, which means that over 500,000 Canadians suffer from this condition [4]. In addition, the prevalence of suicide is high in the BPD population, with a lifetime prevalence of suicide attempts at up to 30% in 1996 in an American context [5]. "
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    ABSTRACT: Bipolar disorder (BPD) is prevalent and is associated with a significant economic burden. Asenapine, the first tetracyclic antipsychotic approved in Canada for the treatment of BPD, has shown a comparable efficacy profile to other atypical antipsychotics. In addition, it is associated with a favourable metabolic profile and minimal weight gain potential. This study aimed to assess the economic impact of asenapine compared to olanzapine in the treatment of BPD in Canada. A decision tree combined with a Markov model was constructed to assess the cost-utility of asenapine compared with olanzapine. The decision tree takes into account the occurrence of extrapyramidal symptoms (EPS), the probability of switching to a different antipsychotic, and the probability of gaining weight. The Markov model takes into account long-term metabolic complications including diabetes, hypertension, coronary heart diseases (CHDs), and stroke. Analyses were conducted from both a Canadian Ministry of Health (MoH) and a societal perspective over a five-year time horizon with yearly cycles. In the treatment of BPD, asenapine is a dominant strategy over olanzapine from both a MoH and a societal perspective. In fact, asenapine is associated with lower costs and more quality-adjusted life years (QALYs). Results of the probabilistic sensitivity analysis indicated that asenapine remains a dominant strategy in 99.2% of the simulations, in both a MoH and a societal perspective, and this result is robust to the many deterministic sensitivity analyses performed. This economic evaluation demonstrates that asenapine is a cost-effective strategy compared to olanzapine in the treatment of BPD in Canada.
    BMC Psychiatry 01/2014; 14(1):16. DOI:10.1186/1471-244X-14-16 · 2.21 Impact Factor
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