Department of Neuroscience, Trondheim Norwegian University of Science and Technology (NTNU), Oslo, Norway.
Bipolar Disord. 2012 Nov;14(7):727-34. doi: 10.1111/bdi.12004. Epub 2012 Sep 21.
The main aim of this study was to assess possible clinical characteristics of acutely admitted bipolar I disorder (BD-I) and bipolar II disorder (BD-II) inpatients at high risk of suicide by comparing patients who had made one or several serious suicide attempts with patients who had not.
A total of 206 consecutive patients (mean age 42 ± 15 years; 54.9% women) with DSM-IV diagnosed BD-I (n = 140) and BD-II (n= 66) acutely admitted to a single psychiatric hospital department from November 2002 through June 2009 were included. Using a detailed retrospective questionnaire, patients with a history of a serious suicide attempt were compared to those with no history of a suicide attempt.
Ninety-three patients (45.1%) had a history of one or more serious suicide attempts. These constituted 60 (42.9%) of the BD-I patients and 33 (50%) of the BD-II patients (no significant difference). Lifetime suicide attempt was associated with a higher number of hospitalizations due to depression (p < 0.0001), antidepressant (AD)-induced hypomania/mania (p = 0.033), AD- and/or alcohol-induced affective episodes (p = 0.009), alcohol and/or substance use (p = 0.002), and a family history of alcohol abuse and/or affective disorder (p = 0.01). Suicide attempt was negatively associated with a higher Positive and Negative Syndrome Scale for Schizophrenia (PANSS) Positive Subscale score (p = 0.022) and more hospitalizations due to mania (p = 0.006).
The lifetime suicide attempt rate in BD inpatients is high. Risk factors of suicide attempts were: (i) a predominant depressive course of illness, (ii) comorbid alcohol and substance use disorders, and (iii) a history of AD- and/or alcohol-induced affective episodes. Risk-reducing factors were a preponderant manic or psychotic course of the illness. These risk factors may be signs of a clinical subgroup at risk of suicidal behaviour, and seem to be important for suicide risk assessment in acutely admitted BD patients.
本研究的主要目的是通过比较有过一次或多次严重自杀企图的患者与无自杀企图的患者，评估高自杀风险的急性入院双相情感障碍 I 型（BD-I）和双相情感障碍 II 型（BD-II）患者的可能临床特征。
共纳入 206 例 2002 年 11 月至 2009 年 6 月连续急性入院于一家精神科病房的 DSM-IV 诊断为 BD-I（n=140）和 BD-II（n=66）的患者。使用详细的回顾性问卷，比较有严重自杀企图史的患者与无自杀企图史的患者。
93 例患者（45.1%）有过一次或多次严重自杀企图。这些患者中，60 例（42.9%）为 BD-I 患者，33 例（50%）为 BD-II 患者（无显著差异）。终生自杀企图与因抑郁（p<0.0001）、抗抑郁药（AD）引起的轻躁狂/躁狂（p=0.033）、AD 和/或酒精引起的情感发作（p=0.009）、酒精和/或物质使用（p=0.002）以及酒精滥用和/或情感障碍家族史（p=0.01）而住院的次数更多有关。自杀企图与阳性和阴性综合征量表（PANSS）阳性量表评分较低（p=0.022）以及因躁狂而住院的次数更多呈负相关（p=0.006）。
BD 住院患者的终生自杀企图率较高。自杀企图的危险因素为：（i）以抑郁为主的疾病病程，（ii）共病酒精和物质使用障碍，以及（iii）AD 和/或酒精引起的情感发作史。降低自杀风险的因素是疾病以躁狂或精神病为主的病程。这些危险因素可能是具有自杀行为风险的临床亚群的标志，对急性入院 BD 患者的自杀风险评估很重要。
