Köhler-Forsberg Ole, Madsen Trine, Behrendt-Møller Ida, Sylvia Louisa, Bowden Charles L, Gao Keming, Bobo William V, Trivedi Madhukar H, Calabrese Joseph R, Thase Michael, Shelton Richard C, McInnis Melvin, Tohen Mauricio, Ketter Terence A, Friedman Edward S, Deckersbach Thilo, McElroy Susan L, Reilly-Harrington Noreen A, Nierenberg Andrew A
Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark; Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Affect Disord. 2017 Dec 1;223:146-152. doi: 10.1016/j.jad.2017.07.038. Epub 2017 Jul 20.
Suicidal ideation occurs frequently among individuals with bipolar disorder; however, its course and persistence over time remains unclear. We aimed to investigate 6-months trajectories of suicidal ideation among adults with bipolar disorder.
The Bipolar CHOICE study randomized 482 outpatients with bipolar disorder to 6 months of lithium- or quetiapine-based treatment including other psychotropic medications as clinically indicated. Participants were asked at 9 visits about suicidal ideation using the Concise Health Risk Tracking scale. We performed latent Growth Mixture Modelling analysis to empirically identify trajectories of suicidal ideation. Multinomial logistic regression analyses were applied to estimate associations between trajectories and potential predictors.
We identified four distinct trajectories. The Moderate-Stable group represented 11.1% and was characterized by constant suicidal ideation. The Moderate-Unstable group included 2.9% with persistent thoughts about suicide with a more fluctuating course. The third (Persistent-low, 20.8%) and fourth group (Persistent-very-low, 65.1%) were characterized by low levels of suicidal ideation. Higher depression scores and previous suicide attempts (non-significant trend) predicted membership of the Moderate-Stable group, whereas randomized treatment did not.
No specific treatments against suicidal ideation were included and suicidal thoughts may persist for several years.
More than one in ten adult outpatients with bipolar disorder had moderately increased suicidal ideation throughout 6 months of pharmacotherapy. The identified predictors may help clinicians to identify those with additional need for treatment against suicidal thoughts and future studies need to investigate whether targeted treatment (pharmacological and non-pharmacological) may improve the course of persistent suicidal ideation.
自杀观念在双相情感障碍患者中频繁出现；然而，其随时间的发展过程和持续性仍不清楚。我们旨在调查双相情感障碍成年人中自杀观念的6个月轨迹。
双相情感障碍选择研究将482名双相情感障碍门诊患者随机分为接受基于锂盐或喹硫平的治疗6个月，治疗包括根据临床指征使用的其他精神药物。在9次访视时，使用简明健康风险跟踪量表询问参与者有关自杀观念的情况。我们进行了潜在增长混合模型分析，以实证确定自杀观念的轨迹。应用多项逻辑回归分析来估计轨迹与潜在预测因素之间的关联。
我们确定了四种不同的轨迹。中度稳定组占11.1%，其特征是持续存在自杀观念。中度不稳定组包括2.9%的患者，他们持续有自杀想法，病程波动较大。第三组（持续低水平，20.8%）和第四组（持续极低水平，65.1%）的特征是自杀观念水平较低。较高的抑郁评分和既往自杀未遂（非显著趋势）预测了中度稳定组的成员身份，而随机治疗则没有。
未纳入针对自杀观念的特定治疗，自杀想法可能会持续数年。
超过十分之一的双相情感障碍成年门诊患者在6个月的药物治疗期间自杀观念中度增加。所确定的预测因素可能有助于临床医生识别那些需要额外治疗以对抗自杀想法的患者，未来的研究需要调查针对性治疗（药物和非药物）是否可以改善持续自杀观念的病程。
