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Clinical and dimensional characteristics of euthymic bipolar patients with or without suicidal behavior

Published online by Cambridge University Press:  05 October 2011

C. Parmentier ,
B. Etain ,
L. Yon ,
H. Misson ,
F. Mathieu ,
M. Lajnef ,
B. Cochet ,
A. Raust ,
J.-P. Kahn  and
O. Wajsbrot-Elgrabli
...Show all authors
C. Parmentier*
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France
B. Etain
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France Fondation Fondamental, 94000Créteil, France
L. Yon
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France
H. Misson
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France
F. Mathieu
Affiliation:
Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France Fondation Fondamental, 94000Créteil, France
M. Lajnef
Affiliation:
Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France
B. Cochet
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France
A. Raust
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France
J.-P. Kahn
Affiliation:
Fondation Fondamental, 94000Créteil, France Service de psychiatrie et psychologie clinique, hôpitaux de Brabois, CHU de Nancy, 54500Vandœuvre-Les-Nancy, France
O. Wajsbrot-Elgrabli
Affiliation:
Service de psychiatrie et psychologie clinique, hôpitaux de Brabois, CHU de Nancy, 54500Vandœuvre-Les-Nancy, France
R. Cohen
Affiliation:
Service de psychiatrie et psychologie clinique, hôpitaux de Brabois, CHU de Nancy, 54500Vandœuvre-Les-Nancy, France
C. Henry
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France Université Paris-Est, faculté de médecine, IFR10, 94000Créteil, France Fondation Fondamental, 94000Créteil, France
M. Leboyer
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France Université Paris-Est, faculté de médecine, IFR10, 94000Créteil, France Fondation Fondamental, 94000Créteil, France
F. Bellivier
Affiliation:
AP–HP, groupe Henri-Mondor-Albert-Chenevier, pôle de psychiatrie, 94000Créteil, France Inserm, unité 955, IMRB, équipe de psychiatrie génétique, 94000Créteil, France Université Paris-Est, faculté de médecine, IFR10, 94000Créteil, France Fondation Fondamental, 94000Créteil, France
*
*Corresponding author. E-mail address:claire.sanz-parmentier@hmn.aphp.fr (C. Parmentier).
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Abstract

Background

The clinical and dimensional features associated with suicidal behaviour in bipolar patients during euthymic states are not well characterised.

Methods

In a sample of 652 euthymic bipolar patients, we assessed clinical features with the Diagnostic Interview for Genetics Studies (DIGS) and dimensional characteristics with questionnaires measuring impulsivity/hostility and affective lability/intensity. Bipolar patients with and without suicidal behaviour were compared for these clinical and dimensional variables.

Results

Of the 652 subjects, 42.9% had experienced at least one suicide attempt. Lifetime history of suicidal behaviour was associated with being a woman, a history of head injury, tobacco misuse and indicators of severity of bipolar disorder including early age at onset, high number of depressive episodes, positive history of rapid cycling, alcohol misuse and social phobia. Indirect hostility and irritability were dimensional characteristics associated with suicidal behaviour in bipolar patients, whereas impulsivity and affective lability/intensity were not associated with suicidal behaviour.

Limitations

This study had a retrospective design with no replication sample.

Conclusions

Bipolar patients with earlier onset, mood instability (large number of depressive episodes, rapid cycling) and/or particular addictive and anxiety comorbid disorders might be at high risk of suicidal behaviour. In addition, hostility dimensions (indirect hostility and irritability), may be trait components associated with suicidal behaviour in euthymic bipolar patients.

Keywords

Bipolar disorderSuicidal behaviourSeverity of illnessComorbid disordersPsychological dimensionsHostility
Type
Original articles
Information
European Psychiatry , Volume 27 , Issue 8 , November 2012 , pp. 570 - 576
Copyright
Copyright © European Psychiatric Association 2012

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References

Abreu, L.N., Lafer, B., Baca-Garcia, E., Oquendo, M.A.Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician. Rev Bras Psiquiatr. 2009; 31 3: 271–280.CrossRefGoogle ScholarPubMed
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th edition, revised edn 1994 American Psychiatric Association Washington, DC.Google Scholar
American Psychiatric Association Practice guideline for the assessment and treatment of patients with suicidal behaviors. Am J Psychiatry. 160 11 Suppl 2003 1–60.Google Scholar
Angst, J., Angst, F., Gerber-Werder, R., Gamma, A.Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years’ follow-up. Arch Suicide Res. 2005; 9 3: 279–300.CrossRefGoogle Scholar
Barratt, E.S.Factor analysis of some psychometric measures of impulsiveness and anxiety. Psychol Rep. 1965; 16: 547–554.CrossRefGoogle ScholarPubMed
Bayle, F.J., Bourdel, M.C., Caci, H., Gorwood, P., Chignon, J.M., Ades, J.et al.Factor analysis of french translation of the Barratt impulsivity scale (BIS-10). Can J Psychiatry. 2000; 45 2: 156–165.CrossRefGoogle ScholarPubMed
Bech, P., Rafaelsen, O.J., Kramp, P., Bolwig, T.G.The mania rating scale: scale construction and inter-observer agreement. Neuropharmacology. 1978; 17 6: 430–431.CrossRefGoogle ScholarPubMed
Brent, D.A., Oquendo, M., Birmaher, B., Greenhill, L., Kolko, D., Stanley, B.et al.Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters. Arch Gen Psychiatry. 2002; 59 9: 801–807.CrossRefGoogle ScholarPubMed
Brodsky, B.S., Oquendo, M., Ellis, S.P., Haas, G.L., Malone, K.M., Mann, J.J.The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression. Am J Psychiatry. 2001; 158 11: 1871–1877.CrossRefGoogle ScholarPubMed
Buss, A.H.The psychology aggression. New York: Wiley; 1961.CrossRefGoogle Scholar
Buss, A.H., Durkee, A.An inventory for assessing different kinds of hostility. J Consult Psychol. 1957; 21 4: 343–349.CrossRefGoogle ScholarPubMed
Carballo, J.J., Harkavy-Friedman, J., Burke, A.K., Sher, L., Baca-Garcia, E., Sullivan, G.M.et al.Family history of suicidal behavior and early traumatic experiences: additive effect on suicidality and course of bipolar illness?. J Affect Disord. 109 1–2: 2008 57–63.CrossRefGoogle ScholarPubMed
Chen, Y.W., Dilsaver, S.C.Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biol Psychiatry. 1996; 39 10: 896–899.CrossRefGoogle ScholarPubMed
Fagiolini, A., Kupfer, D.J., Rucci, P., Scott, J.A., Novick, D.M., Frank, E.Suicide attempts and ideation in patients with bipolar I disorder. J Clin Psychiatry. 2004; 65 4: 509–514.CrossRefGoogle ScholarPubMed
Galfalvy, H., Oquendo, M.A., Carballo, J.J., Sher, L., Grunebaum, M.F., Burke, A.et al.Clinical predictors of suicidal acts after major depression in bipolar disorder: a prospective study. Bipolar Disord. 8 5 Pt 2 2006 586–595.CrossRefGoogle ScholarPubMed
Goodwin, F.K.J., K.R., Manic-depressive illness: bipolar disorders and recurrent depression. New York: Oxford University Press; 2007.Google Scholar
Gray, S.M., Otto, M.W.Psychosocial approaches to suicide prevention: applications to patients with bipolar disorder. J Clin Psychiatry. 62 suppl. 25: 2001 56–64.Google ScholarPubMed
Guillaume, S., Jaussent, I., Jollant, F., Rihmer, Z., Malafosse, A., Courtet, P.Suicide attempt characteristics may orientate toward a bipolar disorder in attempters with recurrent depression. J Affect Disord. 122 1–2: 2010 53–59.CrossRefGoogle Scholar
Harris, E.C., Barraclough, B.Suicide as an outcome for mental disorders. A meta-analysis. Br J Psychiatry. 1997; 170: 205–228.CrossRefGoogle ScholarPubMed
Harvey, P.D., Greenberg, B.R., Serper, M.R.The affective lability scales: development, reliability, and validity. J Clin Psychol. 1989; 45 5: 786–793.3.0.CO;2-P>CrossRefGoogle Scholar
Hawton, K., Sutton, L., Haw, C., Sinclair, J., Harriss, L.Suicide and attempted suicide in bipolar disorder: a systematic review of risk factors. J Clin Psychiatry. 2005; 66 6: 693–704.CrossRefGoogle ScholarPubMed
Henry, C., Van den Bulke, D., Bellivier, F., Roy, I., Swendsen, J., M’Bailara, K.et al.Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Res. 159 1–2: 2008 1–6.CrossRefGoogle ScholarPubMed
Hughes, S.L., Neimeyer, R.A.Cognitive predictors of suicide risk among hospitalized psychiatric patients: a prospective study. Death Stud. 1993; 17 2: 103–124.CrossRefGoogle ScholarPubMed
Jamison, K.R.Suicide and bipolar disorder. J Clin Psychiatry. 61Suppl9 2000 47–51.Google Scholar
Josepho, S.A., Plutchik, R.Stress, coping, and suicide risk in psychiatric inpatients. Suicide Life Threat Behav. 1994; 24 1: 48–57.Google ScholarPubMed
Larsen, R.J., Diener, E., Emmons, R.A.Affect intensity and reactions to daily life events. J Pers Soc Psychol. 1986; 51 4: 803–841.CrossRefGoogle Scholar
Leverich, G.S., Altshuler, L.L., Frye, M.A., Suppes, T., Keck, P.E. Jr., McElroy, S.L.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.CrossRefGoogle ScholarPubMed
Links, P.S., Eynan, R., Heisel, M.J., Barr, A., Korzekwa, M., McMain, S.et al.Affective instability and suicidal ideation and behavior in patients with borderline personality disorder. J Pers Disord. 2007; 21 1: 72–86.CrossRefGoogle ScholarPubMed
Lopez, P., Mosquera, F., De Leon, J., Gutierrez, M., Ezcurra, J., Ramirez, F.et al.Suicide attempts in bipolar patients. J Clin Psychiatry. 2001; 62 12: 963–966.CrossRefGoogle ScholarPubMed
Mann, J.J.Neurobiology of suicidal behaviour. Nat Rev Neurosci. 2003; 4 10: 819–828.CrossRefGoogle ScholarPubMed
McIntyre, R.S., Konarski, J.Z.Bipolar disorder: a national health concern. CNS Spectr. 9 11 Suppl 12 2004 6–15.CrossRefGoogle ScholarPubMed
McIntyre, R.S., Soczynska, J.K., Mancini, D., Lam, C., Woldeyohannes, H.O., Moon, S.et al.The relationship between childhood abuse and suicidality in adult bipolar disorder. Violence Vict. 2008; 23 3: 361–372.CrossRefGoogle ScholarPubMed
Michaelis, B.H., Goldberg, J.F., Davis, G.P., Singer, T.M., Garno, J.L., Wenze, S.J.Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study. Suicide Life Threat Behav. 2004; 34 2: 172–176.CrossRefGoogle ScholarPubMed
Montgomery, S.A., Asberg, M.A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134: 382–389.CrossRefGoogle ScholarPubMed
Najt, P., Perez, J., Sanches, M., Peluso, M.A., Glahn, D., Soares, J.C.Impulsivity and bipolar disorder. Eur Neuropsychopharmacol. 2007; 17 5: 313–320.CrossRefGoogle ScholarPubMed
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;12(1):1-9.CrossRefGoogle Scholar
Nurnberger, J......I. Jr., Blehar, M.C., Kaufmann, C.A., York-Cooler, C., Simpson, S.G., Harkavy-Friedman, J.et al.Diagnostic interview for genetic studies. Rationale, unique features, and training. NIMH Genetics Initiative. Arch Gen Psychiatry. 1994; 51 11: 849–859[discussion 63-4].CrossRefGoogle ScholarPubMed
Oquendo, M.A., Waternaux, C., Brodsky, B., Parsons, B., Haas, G.L., Malone, K.M.et al.Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters. J Affect Disord. 2000; 59 2: 107–117.CrossRefGoogle ScholarPubMed
Oquendo, M.A., Galfalvy, H., Russo, S., Ellis, S.P., Grunebaum, M.F., Burke, A.et al.Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive disorder or bipolar disorder. Am J Psychiatry. 2004; 161 8: 1433–1441.CrossRefGoogle ScholarPubMed
Osby, U., Brandt, L., Correia, N., Ekbom, A., Sparen, P.Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001; 58 9: 844–850.CrossRefGoogle ScholarPubMed
Perlis, R.H., Miyahara, S., Marangell, L.B., Wisniewski, S.R., Ostacher, M., DelBello, M.P.et al.Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2004; 55 9: 875–881.CrossRefGoogle ScholarPubMed
Perroud, N., Baud, P., Preisig, M., Etain, B., Bellivier, F., Favre, S.et al.Social phobia is associated with suicide attempt history in bipolar inpatients. Bipolar Disord. 2007; 9 7: 713–721.CrossRefGoogle ScholarPubMed
Pompili, M., Rihmer, Z., Innamorati, M., Lester, D., Girardi, P., Tatarelli, R.Assessment and treatment of suicide risk in bipolar disorders. Expert Rev Neurother. 2009; 9 1: 109–136.CrossRefGoogle ScholarPubMed
Rihmer, Z., Dome, P., Gonda, X., Kiss, H.G., Kovacs, D., Seregi, K.et al.Cigarette smoking and suicide attempts in psychiatric outpatients in Hungary. Neuropsychopharmacol Hung. 2007; 9 2: 63–67.Google ScholarPubMed
Simon, N.M., Otto, M.W., Wisniewski, S.R., Fossey, M., Sagduyu, K., Frank, E.et al.Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry. 2004; 161 12: 2222–2229.CrossRefGoogle ScholarPubMed
Simon, G.E., Hunkeler, E., Fireman, B., Lee, J.Y., Savarino, J.Risk of suicide attempt and suicide death in patients treated for bipolar disorder. Bipolar Disord. 2007; 9 5: 526–530.CrossRefGoogle ScholarPubMed
Simon, N.M., Zalta, A.K., Otto, M.W., Ostacher, M.J., Fischmann, D., Chow, C.W.et al.The association of comorbid anxiety disorders with suicide attempts and suicidal ideation in outpatients with bipolar disorder. J Psychiatr Res. 41 3–4: 2007 255–264.CrossRefGoogle ScholarPubMed
Slama, F., Bellivier, F., Henry, C., Rousseva, A., Etain, B., Rouillon, F.et al.Bipolar patients with suicidal behavior: toward the identification of a clinical subgroup. J Clin Psychiatry. 2004; 65 8: 1035–1039.CrossRefGoogle ScholarPubMed
Stewart, C.D., Quinn, A., Plever, S., Emmerson, B.Comparing cognitive behavior therapy, problem solving therapy, and treatment as usual in a high risk population. Suicide Life Threat Behav. 2009; 39 5: 538–547.CrossRefGoogle Scholar
Suicidology AAo. American Association of Suicidology [AAS]. Offical 1998 statistics 2000.Google Scholar
Swann, A.C., Dougherty, D.M., Pazzaglia, P.J., Pham, M., Steinberg, J.L., Moeller, F.G.Increased impulsivity associated with severity of suicide attempt history in patients with bipolar disorder. Am J Psychiatry. 2005; 162 9: 1680–1687.CrossRefGoogle ScholarPubMed
Swann, A.C., Lijffijt, M., Lane, S.D., Steinberg, J.L., Moeller, F.G.Severity of bipolar disorder is associated with impairment of response inhibition. J Affect Disord. 116 1–2: 2009 30–36.CrossRefGoogle ScholarPubMed
Tondo, L., Albert, M.J., Baldessarini, R.J.Suicide rates in relation to health care access in the United States: an ecological study. J Clin Psychiatry. 2006; 67 4: 517–523.CrossRefGoogle Scholar
Valtonen, H.M., Suominen, K., Mantere, O., Leppamaki, S., Arvilommi, P., Isometsa, E.T.Prospective study of risk factors for attempted suicide among patients with bipolar disorder. Bipolar Disord. 8 5 Pt 2 2006 576–585.CrossRefGoogle ScholarPubMed
Wasserman, L., Shaw, T., Vu, M., Ko, C., Bollegala, D., Bhalerao, S.An overview of traumatic brain injury and suicide. Brain Inj. 2008; 22 11: 811–819.CrossRefGoogle ScholarPubMed
World Health Organization (WHO).International suicide rates. 2003.Google Scholar
Wu, C.S., Liao, S.C., Lin, K.M., Tseng, M.M., Wu, E.C., Liu, S.K.Multidimensional assessments of impulsivity in subjects with history of suicidal attempts. Compr Psychiatry. 2009; 50 4: 315–321.CrossRefGoogle ScholarPubMed
Yen, S., Shea, M.T., Sanislow, C.A., Grilo, C.M., Skodol, A.E., Gunderson, J.G.et al.Borderline personality disorder criteria associated with prospectively observed suicidal behavior. Am J Psychiatry. 2004; 161 7: 1296–1298.CrossRefGoogle ScholarPubMed
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