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CNS Drugs
Published in: CNS Drugs 7/2003

01-06-2003 | Therapy in Practice

Suicidal Behaviour in Bipolar Disorder

Risk and Prevention

Authors: Dr Leonardo Tondo, Göran Isacsson, Ross J. Baldessarini

Published in: CNS Drugs | Issue 7/2003

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Abstract

Bipolar (manic-depressive) disorder is a common and severe illness. It is also potentially fatal as a result of accidents and increased mortality associated with comorbid substance use and medical illnesses, but its highest lethality results from suicide. Suicide rates, averaging 0.4% per year in men and women diagnosed with bipolar disorder, are >20-fold higher than in the general population. Suicidal acts often occur early in the illness course and in association with severe depressive and dysphoric-agitated mixed phases of illness, especially following repeated, severe depressions.
Systematic consideration of risk and protective factors enhances assessment of potentially suicidal patients. Short-term interventions employed empirically to manage acute suicidality include close clinical supervision, rapid hospitalisation and use of electroconvulsive treatment. Several plausible therapeutic interventions have limited evidence of long-term effectiveness against mortality risks associated with any psychiatric disorder, including antidepressant, antimanic, antipsychotic and electroconvulsive, as well as psychosocial, treatments. However, in bipolar disorder and other major affective disorders, lithium maintenance treatment is a notable exception, with strong and consistent evidence that it reduces suicidal risk.
The growing range of drugs being introduced to treat acute and long-term phases of bipolar disorder, including antiepileptic drugs, atypical antipsychotics and relatively safe, modern antidepressants, require research assessment for their ability to limit premature mortality from suicide and other causes. For now, however, more can be done to improve treatment in major affective illnesses by application of current knowledge in a systematic fashion, with close and sustained clinical follow-up of patients at risk, hopefully with a resulting reduction of mortality rates.
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Metadata
Title
Suicidal Behaviour in Bipolar Disorder
Risk and Prevention
Authors
Dr Leonardo Tondo
Göran Isacsson
Ross J. Baldessarini
Publication date
01-06-2003
Publisher
Springer International Publishing
Published in
CNS Drugs / Issue 7/2003
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI
https://doi.org/10.2165/00023210-200317070-00003

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