Suicidal behaviour in bipolar disorder

IntroductionBipolar Disorder is a serious, common and disabling mental disorder which is associated to high morbidity and high suicide attempt rates.ObjectivesTo identify clinical and social-demographic variables associated to suicidal behaviour in Bipolar Disorder.MethodsThe samples comprises 124 patients (62.1% females) diagnosed with Bipolar Disorder (ICD-10 diagnosis following DIGS/OPCRIT). The variables selected to the analysis were extracted from DIGS and OPCRIT.ResultsSuicidal behaviour occurs in 27.1% of the patients; the most used method was voluntary drug poisoning; it's more frequent in females, with males using more violent methods - remaining results still unavailable.ConclusionsThis study identifies several clinical and social-demographic variables that can help the clinician to delineate a suicidal profile among his Bipolar patients, hence improving his ability to develop an early intervention plan and suicide prevention strategies.

Download Full-text

Economic impact of suicidality in manic patients with depressive features

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2255 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S603-S603

Author(s):

U. Ösby ◽

E. Jonas ◽

J. Hällgren ◽

M. Pompili

Keyword(s):

Bipolar Disorder ◽

Cause Of Death ◽

Suicidal Behaviour ◽

Attempted Suicide ◽

Limited Information ◽

Mixed Features ◽

First Results ◽

Discharged Patients ◽

Competing Interest ◽

Bipolar Patients

IntroductionThere is limited information published on the specific financial costs of completed and/or attempted suicide in bipolar patients. In the last 15 years, only 6 studies were published. Their results vary considerably due to differences in methods used. Also, information on cost for pure manic versus mixed episodes is lacking. This is surprising, since studies have shown that suicidal behaviour is more common among patients with depressive symptoms than with pure mania, and this difference increases considerably when the mixed-features specifier is applied.ObjectivesWe conducted a registry study with the aim to expand the epidemiological information on suicidal behaviour by episode type in bipolar disorder, and its associated costs.MethodsHealth data were retrieved from the Swedish Patient Register. Data covered the period 1990–2014 and included the number of discharged patients with bipolar diagnosis, hospital re-admissions, and attempted and/or completed suicides. Moreover, we retrieved data on suicide and cause of death from the Swedish Cause of Death register. Analyses were done for the whole sample and stratified by subtypes (mania, depression and mixed forms).ResultsFirst results will be presented at the EPA meeting.ConclusionsThis is a nation-wide Swedish study of completed and attempted suicide in bipolar patients. The hypothesis we will test is that there is a substantial variation between different bipolar disorder subtypes, and that most of the expenditures due to suicidal behaviour in bipolar disorder are linked to mixed forms, mania in combination with depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Cognitive impairment in the euthymic phase of affective disorder

Psychological Medicine ◽

10.1017/s0033291798006862 ◽

1998 ◽

Vol 28 (5) ◽

pp. 1027-1038 ◽

Cited By ~ 196

Author(s):

LARS VEDEL KESSING

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairment ◽

Affective Disorder ◽

Bipolar Affective Disorder ◽

Cognitive Outcome ◽

Case Register ◽

Single Episode ◽

Icd 10 ◽

And Gender ◽

Bipolar Patients

Background. A review of studies of cognition in the euthymic phase of unipolar and bipolar affective disorder reveals diverging results.Methods. The study was designed as a controlled cohort study, with the Danish psychiatric case register of admissions used to identify patients and the Danish civil register to identify controls. Patients who were hospitalized between 19 and 25 years ago with an affective diagnosis and who at interviews fulfilled criteria for a primary affective unipolar or bipolar disorder, according to ICD-10, were compared with age- and gender-matched controls. Interviews and assessment of the cognitive function were made in the euthymic phase of the disorder. In all, 118 unipolar patients, 28 bipolar patients and 58 controls were included. Analyses were adjusted for differences in the level of education and for subclinical depressive and anxiety symptoms.Results. Patients with recurrent episodes were significantly more impaired than patients with a single episode and more impaired than controls. Also, within patients the number of prior episodes seemed to be associated with cognitive outcome. There was no difference in the severity of the dysfunction between unipolar and bipolar patients.Conclusions. Cognitive impairment in out-patients with unipolar and bipolar disorder appears to be associated with the number of affective episodes.

Download Full-text

Clinical Characteristics Associated with Suicide Attempt in Patients with Bipolar Disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.293 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S94-S94

Author(s):

M.-E.-M. Vismara ◽

B. Dell’Osso ◽

C. Dobrea ◽

L. Cremaschi ◽

G. Benedetta ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Attempted Suicide ◽

Suicide Attempts ◽

Analysis Of Covariance ◽

Variable Effect ◽

Clinical Variables ◽

Risk Patients ◽

Competing Interest ◽

Bipolar Patients

IntroductionBipolar disorder (BD) is a chronic, highly disabling condition, associated with a high burden of morbidity and mortality, often secondary to suicidal behaviors. In previous reports, different variables have been associated with a higher risk of suicidal acts, with variable effect.ObjectivesTo evaluate which socio-demographic and clinical variables correlate with suicide attempts in bipolar patients.AimsTo enrich literature data about suicidal behaviour in BD.MethodsA sample of 362 BD patients (DSM IV-TR) was retrospectively collected and divided in two subgroups, in relation to the presence of a previous suicide attempt. Socio-demographic and clinical variables were compared between attempters and non-attempters using Corrected multivariate analysis of covariance (MANCOVA).ResultsA total of 26,2% of analyzed patients attempted suicide in their lifespan, and approximately one third of them had multiple suicide attempts (i.e. ≥ 2; 31%). Depressive polarity at index mood episode, higher number of psychiatric hospitalizations, comorbidity with alcohol abuse, eating disorders and psychiatric poly-comorbidity were significantly associated with suicide attempt. Additionally, treatment with lithium, poly-pharmacotherapy (≥ 4 current drugs) and higher recurrence of psychosocial rehabilitation were significantly more frequent in patients who attempted suicide.ConclusionsThe present paper reported a correlation with some specific clinical variables and the lifetime presence of suicide attempt in patients with BD. Although these retrospective findings did not address the causality issue, they may be of clinical relevance in order to better understand suicidal behavior in BD and to adopt proper strategies to prevent suicide in higher risk patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

The current state of benzodiazepines and Z-drugs use and their influences on bipolar disorder outcomes-A small sample analysis

10.21203/rs.3.rs-394328/v1 ◽

2021 ◽

Author(s):

Yiming Chen ◽

Fan Wang ◽

Lvchun Cui ◽

Haijing Huang ◽

Shuqi Kong ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Sleep Disturbance ◽

Affective Disorder ◽

Sleep Disturbances ◽

Small Sample ◽

Mood Stabilizers ◽

Psychotic Symptoms ◽

Psychiatric Drugs ◽

Bipolar Patients

Abstract Background: Sleep disturbance and benzodiazepines (BZDs)/Z-drugs use are known to be common during affective episodes. Hence, we identified the probable outcomes of bipolar disorder that correlate with BZDs/Z-drugs use, aside from mood symptoms. We conducted an open-label, prospective study to describe the current use of BZDs and Z-drugs by patients with bipolar disorder during affective episodes. We evaluated the difference of characteristics between bipolar patients with sleep disturbance who chose BZDs/Z-drugs, and those who did not chose the drugs during and after affective disorder. The influences of BZDs/Z-drugs use on suicide attempt and psychotic symptoms during affective disorder were also investigated. Results: Seventy patients with current affective episodes were studied. Among them, 61 had sleep disturbances. The amount of mood stabilizers use in the BZDs/Z-drugs group was significantly greater than that in the no BZDs/Z-drugs group (p=0.038) during affective episodes. After affective episode, sleep disturbances, especially midnight wakes, became more improved in BZDs/Z-drugs group compared to the no BZDs/Z-drugs group. By contrast, attention and decisiveness became more improved in the no BZDs/Z-drugs group than in the BZDs/Z-drugs group. Furthermore, we observed that BZDs/Z-drugs had an OR of 4.338 (95% CI 1.068-17.623, p=0.040), and other psychiatric drugs had an OR of 1.835 (95% CI 1.105-3.047, p=0.019) in relation to suicide attempt. After nine months, we found that BZDs/Z-drugs use was of no significant effect to depressive or manic severity, or to recurrence rate.Conclusion: BZDs/Z-drugs use have no significant influence on variations in depressive or manic severity during the course of an affective episode. Nevertheless, BZDs/Z-drugs users took a greater amount of mood stabilizers than no BZDs/Z-drugs users. Finally, BZDs/Z-drugs or other psychiatric drugs polytherapy was regarded as a risk factor of suicide attempt during an affective episode.

Download Full-text

The relationship between affective temperament and suicide attempt, clinical history and current subclinical symptoms in bipolar disorder

DIVERSITATES International Journal ◽

10.53357/cpav4969 ◽

2018 ◽

Vol 9 (3) ◽

pp. 65

Author(s):

Rafael Assis Da Silva ◽

Daniel Mograbi ◽

Luiza Nogueira Amadeo ◽

Cristina MT Santana ◽

Jesus Landeira-Fernandez ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Clinical Course ◽

Depressive Mood ◽

First Episode ◽

Hamilton Depression Scale ◽

Affective Temperament ◽

History Of ◽

Bipolar Patients ◽

Depressive Episodes

Background: Affective temperament may strongly influence psychopathological characteristics in mood disorders such as clinical course of major or minor affective episodes, predominant polarity, clinical symptoms, long term clinical course, suicidality, and response/adherence to medication.Objective: The objective of this work is evaluate the association between affective temperament and clinical characteristics in bipolar disorder (BD) patients.Method: 88 euthymic bipolar patients were evaluated through Hamilton Depression Scale (HAM-D), Young Mania Rating Scale (YMRS), Clinical Global Impressions Scale for use in bipolar illness (CGI-BP), and TEMPS-Rio de Janeiro. Identification, sociodemographic data, and clinical information as age on disease onset, number of manic episodes, number of depressive episodes, polarity of first affective episode, and history of suicidal attempts, if any, from each patient were collected.Results: Our results founded that high scores in cyclothymic, irritable, depressive and anxious temperaments were associated with at least one suicide attempt. Higher scores of anxious temperament were associated with depressive polarity in the first episode of the disease as well as higher amount of manic episodes. Higher scores of hyperthymic temperament were associated with manic polarity in the first episode of the disease. Higher scores of depressive temperament were associated with higher scores in total HAM-D and specifically with higher scores in items 1 and 2 of HAM-D, i.e., depressive mood and guilt. No correlation was found between temperament and intensity of subsyndromal manic symptoms.Conclusion: We concluded that affective temperaments in BD are associated with history of suicide attempts, seem to influence polarity of first episode and that depressive temperament seems to relate to more intense subsyndromal depressive symptoms, especially depressive mood and guilt.

Download Full-text

Obesity is associated with previous suicide attempts in bipolar disorder

Acta Neuropsychiatrica ◽

10.1111/j.1601-5215.2010.00452.x ◽

2010 ◽

Vol 22 (2) ◽

pp. 63-67 ◽

Cited By ~ 23

Author(s):

Fabiano A. Gomes ◽

Márcia Kauer-Sant’Anna ◽

Pedro V. Magalhães ◽

Felice N. Jacka ◽

Seetal Dodd ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempt ◽

Suicide Attempts ◽

University Hospital ◽

Comprehensive Management ◽

History Of ◽

Axis I ◽

Dsm Iv ◽

Bipolar Patients ◽

The University

Gomes FA, Kauer-Sant’Anna M, Magalhães PV, Jacka FN, Dodd S, Gama CS, Cunha Â, Berk M, Kapczinski F. Obesity is associated with previous suicide attempts in bipolar disorder.Objective:There is a paucity of data about risk factors for suicide attempts in bipolar disorder. The aim of this study is to examine the association between suicide attempts and obesity in people with bipolar disorder.Methods:Two hundred fifty-five DSM-IV out-patients with bipolar disorder were consecutively recruited from the Bipolar Disorder Program at Hospital das Clínicas de Porto Alegre and the University Hospital at the Universidade Federal de Santa Maria, Brazil. Diagnosis and clinical variables were assessed with Structured Clinical Interview for DSM-IV-axis I (SCID I) and Program structured protocol. History of suicide attempts was obtained from multiple information sources including patients, relatives and review of medical records. Patients with body mass index (BMI) ≥ 30 were classified as obese.Results:Over 30% of the sample was obese and over 50% had a history of suicide attempt. In the multivariate model, obese patients were nearly twice (OR = 1.97, 95% CI: 1.06–3.69, p = 0.03) as likely to have a history of suicide attempt(s).Conclusion:Our results emphasise the relevance of obesity as an associated factor of suicide attempts in bipolar disorder. Obesity may be seen as correlate of severity and as such, must be considered in the comprehensive management of bipolar patients.

Download Full-text

Patients’ adherence to smartphone apps in the management of bipolar disorder: a systematic review

International Journal of Bipolar Disorders ◽

10.1186/s40345-021-00224-6 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Marie-Camille Patoz ◽

Diego Hidalgo-Mazzei ◽

Bruno Pereira ◽

Olivier Blanc ◽

Ingrid de Chazeron ◽

...

Keyword(s):

Systematic Review ◽

Bipolar Disorder ◽

Mobile Health ◽

Smartphone Apps ◽

Exclusion Criteria ◽

Future Studies ◽

Health Apps ◽

Definition Of ◽

Bipolar Patients ◽

Digital Or

Abstract Background Despite an increasing number of available mental health apps in the bipolar disorder field, these tools remain scarcely implemented in everyday practice and are quickly discontinued by patients after downloading. The aim of this study is to explore adherence characteristics of bipolar disorder patients to dedicated smartphone interventions in research studies. Methods A systematic review following PRISMA guidelines was conducted. Three databases (EMBASE, PsychInfo and MEDLINE) were searched using the following keywords: "bipolar disorder" or "mood disorder" or “bipolar” combined with “digital” or “mobile” or “phone” or “smartphone” or “mHealth” or “ehealth” or "mobile health" or “app” or “mobile-health”. Results Thirteen articles remained in the review after exclusion criteria were applied. Of the 118 eligible studies, 39 did not provide adherence characteristics. Among the selected papers, study length, sample size and definition of measures of adherence were strongly heterogeneous. Activity rates ranged from 58 to 91.6%. Conclusion The adherence of bipolar patients to apps is understudied. Standardised measures of adherence should be defined and systematically evaluated in future studies dedicated to these tools.

Download Full-text

Response Processes to Looming Appetitive and Aversive Cues in Euthymic Bipolar Patients and Their First-Degree Relatives: An Exploratory Study

Indian Journal of Psychological Medicine ◽

10.1177/0253717620975285 ◽

2020 ◽

pp. 025371762097528

Author(s):

Velprashanth Venkatesan ◽

Christoday R J Khess ◽

Umesh Shreekantiah ◽

Nishant Goyal ◽

K. K. Kshitiz

Keyword(s):

Bipolar Disorder ◽

Healthy Controls ◽

Sensitivity To Reward ◽

Bipolar Group ◽

First Degree Relatives ◽

Vulnerability Model ◽

Increased Sensitivity ◽

Appetitive Cues ◽

Spectrum Disorders ◽

Bipolar Patients

Background: Patients with bipolar disorder demonstrate increased sensitivity to appetitive/rewarding stimuli even during euthymia. On presentation of arousing pictures, they show a peculiar response, suggesting heightened vigilance. While responding to looming arousing cues, studies show subjects with anxiety spectrum disorders exhibit increased reaction time (RT), explained by the “looming-vulnerability model.” This study aimed to investigate the responses to looming arousing cues in euthymic bipolar patients and their first-degree relatives, as compared to healthy controls. Method: A looming appetitive and aversive cue paradigm was designed for assessing the RT of patients to process appetitive and aversive cues. The behavioral inhibition/activation and sensitivity to reward/punishment amongst the groups were also assessed. Results: The bipolar group showed significantly longer RT to process appetitive cues irrespective of the looming condition. Aversive cues elicited significantly longer RT in both the bipolar group and in first-degree relatives, but only when presented with the looming condition. Significant looming bias was elicited in the bipolar group which suggested a particular cognitive style to looming cues. A composite measure of RT along with sensitivity to reward/punishment distinguishes the bipolar group and their first-degree relatives from the healthy controls. Conclusion: The looming vulnerability model may provide important insights for future exploration of cognitive endophenotypes in bipolar disorder.

Download Full-text