Faculty of Medicine and Dentistry, Palacky University Olomouc, Department of Psychiatry, Olomouc University Hospital, I. P. Pavlova 6, 77500 Olomouc, Czech Republic,
Psychiatr Danub. 2014 Jun;26(2):108-14.
Suicide is a leading cause of death in patients with bipolar disorder. Risk factors and prevention of suicide in this illness are the focus of considerable current research.
MEDLINE data base was searched for the key words "bipolar disorder" with "suicide", "lithium" with "suicide", "anticonvulsants" with "bipolar disorder", and "anticonvulsants" with "bipolar disorder" and with "suicide". No language or time constraints were applied. The lists of references were searched manually to find additional articles.
It is estimated that 25% to 50% of patients with bipolar disorder will attempt suicide at least once over their lifetime, and that 8% to 19% will complete suicide. Mortality rates from cardiovascular diseases are elevated in bipolar disorder. Risk factors for suicide include younger age of onset of the illness, history of past suicidal behavior, family history of suicide acts, comorbid borderline personality disorder and substance use disorders, and hopelessness. The warning signs calling for immediate action include the patients threatening to harm themselves, or looking for ways to kill themselves (seeking access to pills or weapons), or the patient talking or writing about death. Robust evidence supports the effects of lithium treatment in reducing suicidal attempts and completions in bipolar disorder. The evidence for antisuicidal effects of anticonvulsants is weaker. Nevertheless, valproate and other anticonvulsants are frequently prescribed as mood stabilizers. There have been controversial suggestions that this treatment may elevate the risk of suicide, but the data supporting this are not convincing. Psychoeducation can reduce the number of suicide attempts and completions.
Suicide in bipolar disorder is a major public health problem. Recent research has expanded our knowledge of risk factors and warning signs. Nevertheless, it appears that the introduction of lithium treatment in the 1970s was the most recent important breakthrough in the prevention of suicide in this illness.
自杀是双相情感障碍患者的主要死亡原因。该疾病的自杀风险因素和预防是当前大量研究的重点。
在 MEDLINE 数据库中，以“双相情感障碍”和“自杀”、“锂”和“自杀”、“抗惊厥药”和“双相情感障碍”、“抗惊厥药”和“双相情感障碍”和“自杀”为关键词进行搜索。未设置语言或时间限制。手动搜索参考文献列表以查找其他文章。
据估计，双相情感障碍患者中有 25%至 50%至少会在一生中尝试自杀一次，8%至 19%会完成自杀。双相情感障碍患者的心血管疾病死亡率升高。自杀的风险因素包括疾病发病年龄较早、过去有自杀行为史、自杀行为家族史、共病边缘型人格障碍和物质使用障碍以及绝望感。需要立即采取行动的警告信号包括患者威胁要伤害自己、或寻找自杀的方法（寻求获取药丸或武器）、或患者谈论或写有关死亡的话题。强有力的证据支持锂治疗在减少双相情感障碍患者自杀企图和自杀完成方面的作用。抗惊厥药抗自杀作用的证据较弱。然而，丙戊酸盐和其他抗惊厥药经常被开为情绪稳定剂。有争议的建议表明，这种治疗可能会增加自杀的风险，但支持这一观点的数据并不令人信服。心理教育可以减少自杀企图和自杀完成的次数。
双相情感障碍中的自杀是一个重大的公共卫生问题。最近的研究扩大了我们对风险因素和警告信号的认识。然而，70 年代引入锂治疗似乎是该疾病预防自杀的最近一次重要突破。
