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Suicidal behaviour in patients with mood disorders[2015.06.16.] - MPT Web-szerkesztőség - Hírkategória: Tudomány The risk of suicidal behaviour in mood disorders is an inherent phenomenon and in patients with major mood disorders it strongly relates to the presence and severity of depressive episode. Suicidal behaviour in patients with mood disorders is state and severity dependent that means that suicidality markedly decreases or vanishes after clinical recovery. However, since the majority of mood disorder patients never commit and more than half of them never attempt suicide, special clinical characteristics of the illness as well as some personality, familial and psycho-social factors should also play a contributory role. Considering the clinically explorable suicide risk factors in patients with major mood disorders (family and/or personal hisotry of suicidal behaviour, early onset of mood disorder, severe depressive episode/hopelessness, agitated/mixed depression, bipolar I or II diagnosis, rapid cycling course, comorbid Axis I and Axis II disorders, adverse life situations, lack of social and medical support, cyclothymic temperament, impulsive aggressive personality features, etc.), suicidal behaviour is predictable with a good chance. Successful acute and long-term pharmacotherapy markedly reduces the risk of attempted and completed suicide, even in this high-risk population. Supplementary psychosocial interventions (psychoeducation and targeted psychotherapies) further improve the results.
"Suicidality is one of the most alarming signs in psychiatry and it is the most hard end-point and most visible treatment outcome in patients with psychiatric disorders. Suicidal behaviour is very complex, multi-causal behaviour, involving several medical-biologic, psychosocial and cultural components, and history of untreated major mood disorders (particularly in the presence of previous suicide attempt) is the most important risk factor. However, because the majority of mood disorder patients never complete (and around 50% of them never attempt) suicide, other familial-genetic, personality, psychosocial and demographic risk factors should also play a significant contributory role. Psychological autopsy studies from different parts of the world consistently show that around 90% of consecutive suicide victims have one or more Axis I (mostly untreated) major psychiatric disorders at the time of their death, and major mood disorders (59-87%) schizophrenia/schizoaffective disorder (10-12%) and substance-use disorders (10-15%) are the most common principal diagnoses. Comorbid anxiety and personality disorders are also frequently present, but they are rare as principal (or only) diagnoses. It has been estimated that 15-19% of severe (mostly hospitalized) patients with major depression would die by suicide. In their meta-analysis of studies on suicide risk in psychiatric disorders, Harris and Barraclough analysed separately the risk of suicide in unipolar major depression and in bipolar disorder. They found that the risk of suicide was about 20-fold for patients with index diagnosis of unipolar major depression, and the same figure for bipolar disorder was 15. However, these studies cannot provide a precise estimation of separate suicide risk in unipolar and bipolar disorder, i.e. they overestimate the risk for unipolar depression and underestimate it for bipolar disorders. The main sources of these are that the index diagnosis frequently change during the long-term course from unipolar depression to bipolar I or bipolar II disorder and in the studies (performed several decades ago) reviewed by the mentioned authors the diagnostic category of bipolar II depression (depression with hypomania but without mania) which is quite common form of bipolar disorders has not been considered separately and it is very likely that the majority of bipolar II patients in these studies were included in the unipolar major depressive subgroup. Indeed, a recent long-term follow-up study showed that the rate of completed suicide was about double in bipolar disorder (types I and II combined) than in unipolar depression. Another three recent population based epidemiological studies also found a substantially higher rate of suicide attempts in bipolar (types I and II combined) than in unipolar major depressive disorder patients."
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