Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters

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: 3.71). 09/2000; 59(2):107-17. DOI: 10.1016/S0165-0327(99)00129-9
Source: PubMed

ABSTRACT 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, Jul 29, 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: Abstract Objectives: To assess the relationship between lifetime suicide attempts (SA), 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, SA, and serum lipids were measured and MetS was calculated. Results: Seventy percent reported at least one SA. 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 · 1.31 Impact Factor
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    27th ECNP Congress, Berlin, Germany; 10/2014
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    • "Some known clinical and sociodemographic factor associated with SB in BP include gender (Nivoli et al., 2011), previous suicidal attempt (Hawton et al., 2005), presence of suicidal ideation (Valtonen et al., 2005; Leverich et al., 2003; Oquendo et al., 2000; Roy-Byrne et al., 1988), early age at onset (Slama et al., 2004; Perlis et al., 2004; Lopez et al., 2001; Tsai et al., 1999), BD II diagnosis (Pompili et al., 2009; Rihmer and Pestality, 1999) alcohol abuse/ misuse (Dalton et al., 2003; Lopez et al., 2001), stimulant abuse (Gonzalez-Pinto et al., 2007), depressive episodes, mixed episodes (Dalton et al., 2003; Oquendo et al., 2000; Goodwin and Jamison, 1990; Pacchiarotti et al., 2011a), family history of suicide (Lopez et al., 2001; Romero et al., 2007), illness duration (Oquendo et al., 2000; Roy-Byrne et al., 1988), any comorbidity (Vieta et al., 1999; Vieta et al., 2000), first-episode polarity (Chaudhury et al., 2007; Ryu et al., 2010; Daban et al., 2006), depressive predominant polarity (Colom et al., 2006), rapid cycling (Garcia- Amador et al., 2009; Cruz et al., 2008), atypical depression (Sanchez-Gistau et al., 2009), impulsivity (Swann et al., 2005) (Malloy-Diniz et al., 2011), poor functional outcome (Rosa et al., 2008), affective temperaments (Pompili et al., 2008; Rihmer et al., 2009; Azorin et al., 2009; Serafini et al., 2011), treatment nature (Pacchiarotti et al., 2011b) and adherence (Gonzalez-Pinto et al., 2006). "
    European Neuropsychopharmacology 10/2013; 23:S370-S371. DOI:10.1016/S0924-977X(13)70585-6 · 5.40 Impact Factor
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