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Clinical characterization of Italian suicide attempters with bipolar disorder

Published online by Cambridge University Press:  20 June 2017

Bernardo Dell’Osso ,
Matteo Vismara ,
Cristina Dobrea ,
Laura Cremaschi ,
Benedetta Grancini ,
Chiara Arici ,
Beatrice Benatti ,
Massimiliano Buoli ,
Terence A. Ketter  and
A. Carlo Altamura
Bernardo Dell’Osso*
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, California, USA
Matteo Vismara
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Cristina Dobrea
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Laura Cremaschi
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Benedetta Grancini
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Chiara Arici
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Beatrice Benatti
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Massimiliano Buoli
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
Terence A. Ketter
Affiliation:
Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford Medical School, Stanford University, California, USA
A. Carlo Altamura
Affiliation:
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Milan, Italy
*
*Address for correspondence: Dr Bernardo Dell’Osso, Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’ Granda Policlinico, Via F. Sforza, 35, 20122 Milan, Italy. (Email: bernardo.dellosso@unimi.it)
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Abstract

Introduction

Bipolar disorder (BD) is a chronic, highly disabling condition associated with psychiatric/medical comorbidity and substantive morbidity, mortality, and suicide risks. In prior reports, varying parameters have been associated with suicide risk.

Objectives

To evaluate sociodemographic and clinical variables characterizing Italian individuals with BD with versus without prior suicide attempt (PSA).

Methods

A sample of 362 Italian patients categorized as BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) was assessed and divided in 2 subgroups: with and without PSA. Sociodemographic and clinical variables were compared between prior attempters and non-attempters using corrected multivariate analysis of variance (MANOVA).

Results

More than one-fourth of BD patients (26.2%) had a PSA, with approximately one-third (31%) of these having>1 PSA. Depressive polarity at onset, higher number of psychiatric hospitalizations, comorbid alcohol abuse, comorbid eating disorders, and psychiatric poly-comorbidity were significantly more frequent (p<.05) in patients with versus without PSA. Additionally, treatment with lithium, polypharmacotherapy (≥4 current drugs) and previous psychosocial rehabilitation were significantly more often present in patients with versus without PSA.

Conclusions

We found several clinical variables associated with PSA in BD patients. Even though these retrospective findings did not address causality, they could be clinically relevant to better understanding suicidal behavior in BD and adopting proper strategies to prevent suicide in higher risk patients.

Keywords

Bipolar disorderclinical characterizationpharmacological treatmentprior suicide attemptsuicide
Type
Original Research
Information
CNS Spectrums , Volume 23 , Issue 4 , August 2018 , pp. 271 - 277
Copyright
© Cambridge University Press 2017 

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References

1. Schaffer, A, Isometsä, ET, Tondo, L, et al. Epidemiology, neurobiology and pharmacological interventions related to suicide deaths and suicide attempts in bipolar disorder: Part I of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry. 2015; 49(9): 785–802.Google Scholar
2. Pompili, M, Gonda, X, Serafini, G, et al. Epidemiology of suicide in bipolar disorders: a systematic review of the literature. Bipolar Disord. 2013; 15(5): 457–490.Google Scholar
3. Nordentoft, M, Mortensen, PB, Pedersen, CB. Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry. 2011; 68(10): 1058–1064.Google Scholar
4. Simon, GE, Hunkeler, E, Fireman, B, Lee, JY, Savarino, J. Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disord. 2007; 9(5): 526–530.Google Scholar
5. Schaffer, A, Sinyor, M, Reis, C, Goldstein, BI, Levitt, AJ. Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disord. 2014; 16(7): 732–740.Google Scholar
6. Dell’Osso, B, Holtzman, JN, Goffin, KC, et al. American tertiary clinic-referred bipolar II disorder compared to bipolar I disorder: more severe in multiple ways, but less severe in a few other ways. J Affect Disord. 2015; 188: 257–262.Google Scholar
7. Dell’Osso, B, Dobrea, C, Cremaschi, L, et al. Italian bipolar II vs I patients have better individual functioning, in spite of overallsimilar illness severity. CNS Spectr. In press. DOI: 10.1017/S1092852915000887.Google Scholar
8. Jamison, KR. Suicide and bipolar disorder. J Clin Psychiatry. 2000; 61(Suppl 9): 47–51.Google Scholar
9. Undurraga, J, Baldessarini, RJ, Valenti, M, Pacchiarotti, I, Vieta, E. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry. 2012; 73(6): 778–782.Google Scholar
10. Novick, DM, Swartz, HA, Frank, E. Suicide attempts in bipolar I and bipolar II disorder: a review and meta-analysis of the evidence. Bipolar Disord. 2010; 12(1): 1–9.Google Scholar
11. Schaffer, A, Isometsä, ET, Azorin, J-M, et al. A review of factors associated with greater likelihood of suicide attempts and suicide deaths in bipolar disorder: Part II of a report of the International Society for Bipolar Disorders Task Force on Suicide in Bipolar Disorder. Aust N Z J Psychiatry. 2015; 49(11): 1006–1020.Google Scholar
12. Tidemalm, D, Haglund, A, Karanti, A, Landén, M, Runeson, B. Attempted suicide in bipolar disorder: risk factors in a cohort of 6086 patients. PLoS One. 2014; 9(4): e94097.Google Scholar
13. Dennehy, EB, Marangell, LB, Allen, MH, Chessick, C, Wisniewski, SR, Thase, ME. Suicide and suicide attempts in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). J Affect Disord. 2011; 133(3): 423–427.Google Scholar
14. Antypa, N, Souery, D, Tomasini, M, et al. Clinical, psychological and environmental predictors of prospective suicide events in patients with bipolar disorder. J Psychiatr Res. 2013; 47(11): 1800–1808.Google Scholar
15. Bellivier, F, Yon, L, Luquiens, A, et al. Suicidal attempts in bipolar disorder: results from an observational study (EMBLEM). Bipolar Disord. 2011; 13(4): 377–386.Google Scholar
16. Goffin, KC, Dell’Osso, B, Miller, S, et al. Different characteristics associated with suicide attempts among bipolar I versus bipolar II disorder patients. J Psychiatr Res. 2016; 76: 94–100.Google Scholar
17. Altamura, AC, Dell’Osso, B, Berlin, HA, Buoli, M, Bassetti, R, Mundo, E. Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci. 2010; 260(5): 385–391.Google Scholar
18. Parmentier, C, Etain, B, Yon, L, et al. Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior. Eur Psychiatry. 2012; 27(8): 570–576.Google Scholar
19. Leverich, GS, Altshuler, LL, Frye, MA, et al. Factors associated with suicide attempts in 648 patients with bipolar disorder in the Stanley Foundation Bipolar Network. J Clin Psychiatry. 2003; 64(5): 506–515.Google Scholar
20. Sánchez-Gistau, V, Colom, F, Mané, A, Romero, S, Sugranyes, G, Vieta, E. Atypical depression is associated with suicide attempt in bipolar disorder. Acta Psychiatr Scand. 2009; 120(1): 30–36.Google Scholar
21. Jiménez, E, Arias, B, Mitjans, M, et al. Clinical features, impulsivity, temperament and functioning and their role in suicidality in patients with bipolar disorder. Acta Psychiatr Scand. 2016; 133(4): 266–276.Google Scholar
22. Undurraga, J, Baldessarini, RJ, Valenti, M, Pacchiarotti, I, Vieta, E. Suicidal risk factors in bipolar I and II disorder patients. J Clin Psychiatry. 2012; 73(6): 778–782.Google Scholar
23. Azorin, JM, Kaladjian, A, Adida, M, et al. Risk factors associated with lifetime suicide attempts in bipolar I patients: findings from a French National Cohort. Compr Psychiatry. 2009; 50(2): 115–120.Google Scholar
24. O’Connor, E, Gaynes, BN, Burda, BU, Soh, C, Whitlock, EP. Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013; 158(10): 741–754.Google Scholar
25. Neves, FS, Malloy-Diniz, LF, Corrêa, H. Suicidal behavior in bipolar disorder: what is the influence of psychiatric comorbidities? J Clin Psychiatry. 2009; 70(1): 13–18.Google Scholar
26. First, M, Gibbon, M, Spitzer, R, Williams, J, Benjamin, L. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press; 1997.Google Scholar
27. First, M, Spitzer, R, Gibbon, M, Williams, J. Structured Clinical Interview for DSM–IV–TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
28. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed, text rev. Washington, DC: American Psychiatric Association; 2000.Google Scholar
29. Barbato, A. Psychosocial rehabilitation and severe mental disorders: a public health approach. World Psychiatry. 2006; 5(3): 162–163.Google Scholar
30. Hall, RC. Global assessment of functioning. A modified scale. Psychosomatics. 1995; 36(3): 267–275.Google Scholar
31. Merikangas, KR, Jin, R, He, J-P, et al. Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Arch Gen Psychiatry. 2011; 68(3): 241–251.Google Scholar
32. Sala, R, Goldstein, BI, Morcillo, C, Liu, S-M, Castellanos, M, Blanco, C. Course of comorbid anxiety disorders among adults with bipolar disorder in the U.S. population. J Psychiatr Res. 2012; 46(7): 865–872.Google Scholar
33. Ryu, V, Jon, D-I, Cho, HS, et al. Initial depressive episodes affect the risk of suicide attempts in Korean patients with bipolar disorder. Yonsei Med J. 2010; 51(5): 641–647.Google Scholar
34. Dell’Osso, B, Shah, S, Do, D, et al. American tertiary clinic-referred bipolar II disorder versus bipolar I disorder associated with hastened depressive recurrence. Int J Bipolar Disord. 2017; 5: 2.Google Scholar
35. Chen, L, Liu, Y-H, Zheng, Q-W, et al. Suicide risk in major affective disorder: results from a national survey in China. J Affect Disord. 2014; 155: 174–179.Google Scholar
36. Dalton, EJ, Cate-Carter, TD, Mundo, E, Parikh, S V, Kennedy, JL. Suicide risk in bipolar patients: the role of co-morbid substance use disorders. Bipolar Disord. 2003; 5(1): 58–61.Google Scholar
37. Finseth, PI, Morken, G, Andreassen, OA, Malt, UF, Vaaler, AE. Risk factors related to lifetime suicide attempts in acutely admitted bipolar disorder inpatients. Bipolar Disord. 2012; 14(7): 727–734.Google Scholar
38. Post, RM, Denicoff, KD, Leverich, GS, et al. Morbidity in 258 bipolar outpatients followed for 1 year with daily prospective ratings on the NIMH life chart method. J Clin Psychiatry. 2003; 64(6): 680–690.Google Scholar
39. Perroud, N, Baud, P, Preisig, M, et al. Social phobia is associated with suicide attempt history in bipolar inpatients. Bipolar Disord. 2007; 9(7): 713–721.Google Scholar
40. Valtonen, HM, Suominen, K, Mantere, O, Leppämäki, S, Arvilommi, P, Isometsä, ET. Prospective study of risk factors for attempted suicide among patients with bipolar disorder. Bipolar Disord. 2006; 8(5 Pt 2): 576–585.Google Scholar
41. Parker, G, Fletcher, K, McCraw, S, Futeran, S, Hong, M. Identifying antecedent and illness course variables differentiating bipolar I, bipolar II and unipolar disorders. J Affect Disord. 2013; 148(2–3): 202–209.Google Scholar
42. Antypa, N, Souery, D, Tomasini, M, et al. Clinical and genetic factors associated with suicide in mood disorder patients. Eur Arch Psychiatry Clin Neurosci. 2016; 266(2): 181–193.Google Scholar
43. Bega, S, Schaffer, A, Goldstein, B, Levitt, A. Differentiating between bipolar disorder types I and II: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Affect Disord. 2012; 138(1–2): 46–53.Google Scholar
44. Song, JY, Yu, HY, Kim, SH, et al. Assessment of risk factors related to suicide attempts in patients with bipolar disorder. J Nerv Ment Dis. 2012; 200(11): 978–984.Google Scholar
45. Ruengorn, C, Sanichwankul, K, Niwatananun, W, Mahatnirunkul, S, Pumpaisalchai, W, Patumanond, J. A risk-scoring scheme for suicide attempts among patients with bipolar disorder in a Thai patient cohort. Psychol Res Behav Manag. 2012; 5: 37–45.Google Scholar
46. D’Ambrosio, V, Salvi, V, Bogetto, F, Maina, G. Serum lipids, metabolic syndrome and lifetime suicide attempts in patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2012; 37(1): 136–140.Google Scholar
47. Sublette, EM, Carballo, JJ, Moreno, C, et al. Substance use disorders and suicide attempts in bipolar subtypes. J Psychiatr Res. 2009; 43(3): 230–238.Google Scholar
48. Michaelis, BH, Goldberg, JF, Singer, TM, Garno, JL, Ernst, CL, Davis, GP. Characteristics of first suicide attempts in single versus multiple suicide attempters with bipolar disorder. Compr Psychiatry. 2003; 44(1): 15–20.Google Scholar
49. Keks, NA, Hill, C, Sundram, S, et al. Evaluation of treatment in 35 cases of bipolar suicide. Aust N Z J Psychiatry. 2009; 43(6): 503–508.Google Scholar
50. Valtonen, HM, Suominen, K, Mantere, O, Leppämäki, S, Arvilommi, P, Isometsä, E. Suicidal behaviour during different phases of bipolar disorder. J Affect Disord. 2007; 97(1–3): 101–107.Google Scholar
51. Neves, FS, Malloy-Diniz, LF, Corrêa, H. Suicidal behavior in bipolar disorder: what is the influence of psychiatric comorbidities? J Clin Psychiatry. 2009; 70(1): 13–18.Google Scholar
52. Oquendo, MA, Currier, D, Liu, S-M, Hasin, DS, Grant, BF, Blanco, C. Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry. 2010; 71(7): 902–909.Google Scholar
53. Moor, S, Crowe, M, Luty, S, Carter, J, Joyce, PR. Effects of comorbidity and early age of onset in young people with bipolar disorder on self harming behaviour and suicide attempts. J Affect Disord. 2012; 136(3): 1212–1215.Google Scholar
54. Swanson, SA, Crow, SJ, Le Grange, D, Swendsen, J, Merikangas, KR. Prevalence and correlates of eating disorders in adolescents. Results from the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry. 2011; 68(7): 714–723.Google Scholar
55. World Health Organization. Preventing suicide. A global imperative. WHO Press, World Health Organization; 2014. http://apps.who.int/iris/bitstream/10665/131056/1/9789241564779_eng.pdf.Google Scholar
56. Baldessarini, RJ, Tondo, L. Lithium and suicidal risk. Bipolar Disord. 2008; 10(1): 114–115.Google Scholar
57. Cipriani, A, Pretty, H, Hawton, K, Geddes, JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry. 2005; 162(10): 1805–1819.Google Scholar
58. Cipriani, A, Hawton, K, Stockton, S, Geddes, JR. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis. BMJ. 2013; 346: f3646.Google Scholar
59. Carvalho, AF, McIntyre, RS, Dimelis, D, et al. Predominant polarity as a course specifier for bipolar disorder: a systematic review. J Affect Disord. 2014; 163: 56–64.Google Scholar
60. Colom, F, Vieta, E, Daban, C, Pacchiarotti, I, Sánchez-Moreno, J. Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord. 2006; 93(1–3): 13–17.Google Scholar
61. Popovic, D, Torrent, C, Goikolea, JM, et al. Clinical implications of predominant polarity and the polarity index in bipolar disorder: a naturalistic study. Acta Psychiatr Scand. 2014; 129(5): 366–374.Google Scholar
62. González-Pinto, A, Alberich, S, Barbeito, S, et al. Different profile of substance abuse in relation to predominant polarity in bipolar disorder. The Vitoria long-term follow-up study. J Affect Disord. 2010; 124(3): 250–255.Google Scholar
63. Azorin, JM, Bellivier, F, Kaladjian, A, et al. Characteristics and profiles of bipolar I patients according to age-at-onset: findings from an admixture analysis. J Affect Disord. 2013; 150(3): 993–1000.Google Scholar
64. Nery-Fernandes, F, Quarantini, LC, Guimarães, JL, et al. Is there an association between suicide attempt and delay of initiation of mood stabilizers in bipolar I disorder? J Affect Disord. 2012; 136(3): 1082–1087.Google Scholar