Suicidality in pediatric bipolar disorder: predictor or outcome of family processes and mixed mood presentation?

Abstract

Objective Pediatric bipolar disorder (PBD) involves a potent combination of mood dysregulation and interpersonal processes, placing these youth at significantly greater risk of suicide. We examined the relationship between suicidal behavior, mood symptom presentation, family functioning, and quality of life (QoL) in youth with PBD. Methods Participants were 138 youths aged 5–18 years presenting to outpatient clinics with DSM-IV diagnoses of bipolar I disorder (n = 27), bipolar II disorder (n = 18), cyclothymic disorder (n = 48), and bipolar disorder not otherwise specified (n = 45). Results Twenty PBD patients had lifetime suicide attempts, 63 had past or current suicide ideation, and 55 were free of suicide ideation and attempts. Attempters were older than nonattempters. Suicide ideation and attempts were linked to higher depressive symptoms, and rates were even higher in youths meeting criteria for the mixed specifier proposed for DSM-5. Both suicide ideation and attempts were associated with lower youth QoL and poorer family functioning. Parent effects (with suicidality treated as outcome) and child effects (where suicide was the predictor of poor family functioning) showed equally strong evidence in regression models, even after adjusting for demographics. Conclusions These findings underscore the strong association between mixed features and suicidality in PBD, as well as the association between QoL, family functioning, and suicidality. It is possible that youths are not just a passive recipient of family processes, and their illness may play an active role in disrupting family functioning. Replication with longitudinal data and qualitative methods should investigate both child and parent effect models.

Omega-3 Supplementation for Psychotic Mania and Comorbid Anxiety in Children

“…Her depressive symptoms were often present in a residual form, both between episodes of major depression and during manic episodes, leading to an overall mixed bipolar presentation. Sarah's mixed symptom presentation is frequent among other children with BD (Kraepelin 1921;Axelson et al 2006;Duax et al 2007;Algorta et al 2011). Mixed presentations result in greater psychosocial impairment and can lead to an enhanced risk of suicide as a result of the coupling of dysphoric mood and hopelessness, with elevated energy and impulsivity (Algorta et al 2011).…”

“…Sarah's mixed symptom presentation is frequent among other children with BD (Kraepelin 1921;Axelson et al 2006;Duax et al 2007;Algorta et al 2011). Mixed presentations result in greater psychosocial impairment and can lead to an enhanced risk of suicide as a result of the coupling of dysphoric mood and hopelessness, with elevated energy and impulsivity (Algorta et al 2011). Symptoms of psychosis occur in *20-35% of children with BD type 1 (Kowatch et al 2005), placing Sarah in this higher severity category with respect to bipolar illness severity.…”

Applying a developmental approach to quality of life assessment in children and adolescents with psychological disorders: challenges and guidelines

“…As shown in Table 2, studies examining the QL of children with the following diagnoses of mental disorder were included: attention deficit hyperactivity disorder (ADHD; n = 27) [18; 32-57]; autism spectrum disorder (n = 10) [58][59][60][61][62][63][64][65][66][67]; Gilles de la Tourette syndrome or other tic disorder (n = 6) [68][69][70][71][72][73]; bipolar spectrum disorders (n = 5) [74][75][76][77][78]; enuresis (n = 3) [79][80][81]; separation anxiety disorder and anxiety disorders (n = 3) [82][83][84]; eating disorders (n = 2) [85][86]; major depressive disorder (n = 2) [87][88]; conduct disorder (n = 1) [89]; obsessive-compulsive disorder (n = 1) [24]; and learning disabilities (n = 1) [90]. Five studies included diverse diagnoses of a mental disorder [13-14, 23, 91-92].…”

Pediyatrik Bipolar Bozuklukta Fenomenolojik Özellikler ve Psikiyatrik Komorbidite

“…Therefore it is important to carefully assess the psychotic symptoms in young subjects with BD both for differential diagnosis and accurate treatment (3,4,10). Young subjects with BD have been reported to have significant rates of suicidal ideation and/or attempts (15,(31)(32)(33). While suicidal ideation has been reported as high as 94% (31), suicide attempt has been reported in one third of the patients (15,32).…”

“…Psychiatric disorders, particularly mood disorders, are among the most important risk factors for youth suicide (34). Therefore young subjects with BD, particularly those with psychotic symptoms and mixed states, should be assessed for suicidal ideation and/or plan in terms of suicide prevention (3,4,(31)(32)(33).…”