Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Bipolar Disord. 2018 Jun;20(4):334-348. doi: 10.1111/bdi.12622. Epub 2018 Feb 19.
Suicide is a multicausal human behavior, with devastating and immensely distressing consequences. Its prevalence is estimated to be 20-30 times greater in patients with bipolar disorders than in the general population. The burden of suicide and its high prevalence in bipolar disorders make it imperative that our current understanding be improved to facilitate prediction of suicide and its prevention. In this review, we provide a new perspective on the process of suicide in bipolar disorder, in the form of a novel integrated model that is derived from extant knowledge and recent evidence.
A literature search of articles on suicide in bipolar disorder was conducted in recognized databases such as Scopus, PubMed, and PsycINFO using the keywords "suicide", "suicide in bipolar disorders", "suicide process", "suicide risk", "neurobiology of suicide" and "suicide models". Bibliographies of identified articles were further scrutinized for papers and book chapters of relevance.
Risk factors for suicide in bipolar disorders are well described, and provide a basis for a framework of epigenetic mechanisms, moderated by neurobiological substrates, neurocognitive functioning, and social inferences within the environment. Relevant models and theories include the diathesis-stress model, the bipolar model of suicide and the ideation-to-action models, the interpersonal theory of suicide, the integrated motivational-volitional model, and the three-step theory. Together, these models provide a basis for the generation of an integrated model that illuminates the suicidal process, from ideation to action.
Suicide is complex, and it is evident that a multidimensional and integrated approach is required to reduce its prevalence. The proposed model exposes and provides access to components of the suicide process that are potentially measurable and may serve as novel and specific therapeutic targets for interventions in the context of bipolar disorder. Thus, this model is useful not only for research purposes, but also for future real-world clinical practice.
自杀是一种多因素导致的人类行为，具有破坏性和极大的痛苦后果。据估计，双相情感障碍患者的自杀率是普通人群的 20-30 倍。自杀的普遍性及其在双相情感障碍中的高发生率，使得我们必须提高对自杀的理解，以促进对自杀的预测和预防。在本文中，我们提供了一种新的视角，即双相情感障碍自杀过程的综合模型，该模型源自现有知识和最近的证据。
在 Scopus、PubMed 和 PsycINFO 等公认的数据库中，使用“自杀”、“双相情感障碍中的自杀”、“自杀过程”、“自杀风险”、“自杀的神经生物学”和“自杀模型”等关键词，对双相情感障碍自杀的文献进行了搜索。还进一步仔细查阅了确定的文章的参考文献，以获取相关的论文和书籍章节。
双相情感障碍自杀的风险因素已有很好的描述，并为一个基于表观遗传机制的框架提供了基础，该框架由神经生物学基质、神经认知功能以及环境中的社会推断来调节。相关的模型和理论包括素质-应激模型、自杀的双相模型和观念-行动模型、人际理论的自杀、综合动机-意志模型和三步理论。这些模型共同为一个综合模型提供了基础，该模型阐明了从观念到行动的自杀过程。
自杀是复杂的，显然需要采用多维和综合的方法来降低其发生率。所提出的模型揭示并提供了对自杀过程潜在可测量的组成部分的访问，这些组成部分可能作为干预双相情感障碍的新的、具体的治疗靶点。因此，该模型不仅对研究有用，而且对未来的现实临床实践也有用。
