BACKGROUND: Previous investigations have reported that suicidal ideation and behavior are more prevalent during mixed than pure mania. Uncertainties exist about whether suicidality in mania arises from multiple concurrent depressive symptoms, or rather, as a categorical phenomenon, reflecting dysphoria without necessarily a full major depression. To elucidate the relationship between suicidal ideation and dysphoric mania, we analyzed clinical and demographic features associated with suicidal versus nonsuicidal dysphoric manic inpatients. METHODS: Records were reviewed for 100 DSM-III-R bipolar I manic inpatients at the Payne Whitney Clinic of New York Hospital from 1991-1995. All had > or = 2 concomitant depressive symptoms (other than suicidality). Affective and psychotic symptoms, past suicide attempts, prior illness, and related clinical/demographic variables were assessed by a standardized protocol. RESULTS: Suicidal ideation was significantly more common among dysphoric manics who were caucasian, took antidepressant medications in the week prior to admission, had histories of alcohol abuse/dependence, and made past suicide attempts. Suicidal ideation was evident for nearly half of dysphoric manic patients with < or = 3 depressive symptoms who did not meet DSM criteria for a mixed state. No individual manic or depressive symptoms other than dysphoric mood were more common among suicidal than nonsuicidal patients. LIMITATIONS: Findings from this retrospective study require confirmation using a prospective assessment. Treatments were naturalistic and may have differentially influenced hospital course and illness characteristics. Factors related to suicide attempts (rare in this cohort) or completions (not a focus of this study) may differ from those related only to suicidal ideation. CONCLUSIONS: Caucasian dysphoric manic patients with past suicide attempts and substance abuse may have a significantly elevated risk for suicidality, even when full major depression does not accompany mania. Suicidality is a clinically important consideration in a majority of dysphoric manic patients.
BACKGROUND: Previous investigations have reported that suicidal ideation and behavior are more prevalent during mixed than pure mania. Uncertainties exist about whether suicidality in mania arises from multiple concurrent depressive symptoms, or rather, as a categorical phenomenon, reflecting dysphoria without necessarily a full major depression. To elucidate the relationship between suicidal ideation and dysphoric mania, we analyzed clinical and demographic features associated with suicidal versus nonsuicidal dysphoric manic inpatients. METHODS: Records were reviewed for 100 DSM-III-R bipolar I manic inpatients at the Payne Whitney Clinic of New York Hospital from 1991-1995. All had > or = 2 concomitant depressive symptoms (other than suicidality). Affective and psychotic symptoms, past suicide attempts, prior illness, and related clinical/demographic variables were assessed by a standardized protocol. RESULTS: Suicidal ideation was significantly more common among dysphoric manics who were caucasian, took antidepressant medications in the week prior to admission, had histories of alcohol abuse/dependence, and made past suicide attempts. Suicidal ideation was evident for nearly half of dysphoric manicpatients with < or = 3 depressive symptoms who did not meet DSM criteria for a mixed state. No individual manic or depressive symptoms other than dysphoric mood were more common among suicidal than nonsuicidal patients. LIMITATIONS: Findings from this retrospective study require confirmation using a prospective assessment. Treatments were naturalistic and may have differentially influenced hospital course and illness characteristics. Factors related to suicide attempts (rare in this cohort) or completions (not a focus of this study) may differ from those related only to suicidal ideation. CONCLUSIONS: Caucasian dysphoric manicpatients with past suicide attempts and substance abuse may have a significantly elevated risk for suicidality, even when full major depression does not accompany mania. Suicidality is a clinically important consideration in a majority of dysphoric manicpatients.
Authors: M Elizabeth Sublette; Juan J Carballo; Carmen Moreno; Hanga C Galfalvy; David A Brent; Boris Birmaher; J John Mann; Maria A Oquendo Journal: J Psychiatr Res Date: 2008-06-30 Impact factor: 4.791
Authors: Jonathan P Stange; Evan M Kleiman; Louisa G Sylvia; Pedro Vieira da Silva Magalhães; Michael Berk; Andrew A Nierenberg; Thilo Deckersbach Journal: Depress Anxiety Date: 2016-01-12 Impact factor: 6.505
Authors: Michael J Ostacher; Andrew A Nierenberg; Dustin Rabideau; Noreen A Reilly-Harrington; Louisa G Sylvia; Alexandra K Gold; Leah W Shesler; Terence A Ketter; Charles L Bowden; Joseph R Calabrese; Edward S Friedman; Dan V Iosifescu; Michael E Thase; Andrew C Leon; Madhukar H Trivedi Journal: J Psychiatr Res Date: 2015-10-09 Impact factor: 4.791
Authors: Alexander H Fan; Mark A Frye; Susan J Hassell; Sun Hwang; Lindsay Kiriakos; Jim Mintz; Michael J Gitlin; Lori L Altshuler Journal: Psychiatry (Edgmont) Date: 2007-04
Authors: Cheryl A Chessick; Deborah A Perlick; David J Miklowitz; L Miriam Dickinson; Michael H Allen; Chad D Morris; Jodi M Gonzalez; Lauren B Marangell; Victoria Cosgrove; Michael Ostacher Journal: Bipolar Disord Date: 2009-12 Impact factor: 6.744