Prevention of suicidal behavior in bipolar disorder

Abstract

Background Excess mortality is a critical hallmark of bipolar disorder (BD) due to co‐occurring general medical disorders and especially from suicide. It is timely to review of the status of suicide in BD and to consider the possibility of limiting suicidal risk. Methods We carried out a semi‐systematic review of recent research reports pertaining to suicide in BD. Findings Suicide risk in BD is greater than with most other psychiatric disorders. Suicide rates (per 100,000/year) are approximately 11 and 4 in the adult and juvenile general populations, but over 200 in adults, and 100 among juveniles diagnosed with BD. Suicide attempt rates with BD are at least 20 times higher than in the adult general population, and over 50 times higher among juveniles. Notable suicidal risk factors in BD include: previous suicidal acts, depression, mixed–agitated‐dysphoric moods, rapid mood‐shifts, impulsivity, and co‐occurring substance abuse. Suicide‐preventing therapeutics for BD remain severely underdeveloped. Evidence favoring lithium treatment is stronger than for other measures, although encouraging findings are emerging for other treatments. Conclusions Suicide is a leading clinical challenge for those caring for BD patients. Improved understanding of risk and protective factors combined with knowledge and close follow‐up of BD patients should limit suicidal risk. Ethically appropriate and scientifically sound studies of plausible medicinal, physical, and psychosocial treatments aimed at suicide prevention specifically for BD patients are urgently needed.

Altered Levels of Plasma Inflammatory Cytokines and White Matter Integrity in Bipolar Disorder Patients With Suicide Attempts

“…Among psychiatric disorders, bipolar disorder (BD) has the highest suicide incidence ( 1 – 4 ). A recent meta-analysis demonstrated that the lifetime prevalence of suicide attempts (SA) in BD was 33.9% ( 5 ), which is at least 20 times higher than the general population ( 6 ). Epidemiological studies also showed that approximately 20–60% of BD patients had attempted suicide in their lifetime, and approximately 4–19% died due to suicide ( 7 ).…”

Trends in big data analyses by multicenter collaborative translational research in psychiatry

“…Moreover, suicide prevention is extremely important, as MDD and BD are high‐risk factors for suicidal thoughts or behaviors in psychiatric patients. 19 , 29 , 30 …”

“…Moreover, suicide prevention is extremely important, as MDD and BD are high-risk factors for suicidal thoughts or behaviors in psychiatric patients. 19,29,30 Autism spectrum disorder is characterized by difficulty with social communication, repetitive behavior, and highly restricted interests or activities. 31 Four separate disorders, including autistic disorder, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder, were integrated into the single entity of ASD in DSM-5.…”

Which Clinical and Biochemical Parameters Are Associated with Lifetime Suicide Attempts in Bipolar Disorder?

“…Of note, a recent multicentric large-sample Italian study identified an earlier age at first contact with psychiatric services and the presence of psychotic symptoms or hospitalizations in the last year among the factors associated with suicidal behavior in bipolar patients [ 21 ]. On the other hand, the identification of the clinical variables predicting self-harm in BD is extremely important to establish proper treatment with anti-suicidal compounds such as lithium [ 22 , 23 ]. Therefore, many studies have been recently undertaken to better understand the pathophysiology of suicide attempts in BD as well as to identify potential peripheral markers of suicidal behavior, with the scope of developing preventive strategies and identifying effective drugs.…”