Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain.
Forensic Genetic Laboratori, University of Barcelona, Catalonia, Spain.
J Affect Disord. 2019 Jan 1;242:111-122. doi: 10.1016/j.jad.2018.08.054. Epub 2018 Aug 23.
Completed suicide is a major cause of death in bipolar disorder (BD) patients.
The aim of this paper is to provide an overall review of the existing literature of completed suicide in BD patients, including clinical and genetic data DATA SOURCES: We performed a systematic review of English and non-English articles published on MEDLINE/PubMed, PsycInfo and Cochrane database (1970-2017). Additional studies were identified by contacting clinical experts, searching bibliographies, major textbooks and website of World Health Organization. Initially we did a broad search for the association of bipolar disorder and suicide and we were narrowing the search in terms included "bipolar disorder" and "completed suicide".
Inclusion criteria were articles about completed suicide in patients with BD. Articles exclusively focusing on suicide attempts and suicidal behaviour have been excluded. We used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) consensus for drafting this systematic review.
The initial search generated 2806 articles and a total of 61 meeting our inclusion criteria. We reviewed epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD. Suicide rates in BD vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population. The highest risk of successful suicide was observed in BD-II subjects. The heritability of completed suicide is about 40% and some genes related to major neurotransmitter systems have been associated with suicide. Lithium is the only treatment that has shown anti-suicide potential.
The most important limitation of the present review is the limited existing literature on completed suicide in BD.
BD patients are at high risk for suicide. It is possible to identify some factors related to completed suicide, such as early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. However it is necessary to promote research on this serious health problem.
自杀是双相障碍（BD）患者的主要死亡原因。
本文旨在全面综述双相障碍患者自杀死亡的现有文献，包括临床和遗传数据。
我们对 MEDLINE/PubMed、PsycInfo 和 Cochrane 数据库（1970-2017 年）发表的英文和非英文文章进行了系统综述。通过联系临床专家、查阅文献、主要教科书和世界卫生组织网站，确定了其他研究。最初，我们广泛搜索了双相障碍与自杀的关联，然后缩小了搜索范围，纳入了“双相障碍”和“自杀死亡”等关键词。
纳入标准为关于 BD 患者自杀死亡的文章。仅关注自杀未遂和自杀行为的文章被排除在外。我们使用 PRISMA（系统评价和荟萃分析的首选报告项目）共识来起草本系统综述。
最初的搜索产生了 2806 篇文章，共有 61 篇符合我们的纳入标准。我们综述了 BD 中自杀死亡的流行病学数据、遗传因素、危险因素和治疗。BD 中的自杀率在不同的研究中有所不同，但我们的分析表明，自杀率大约是普通人群的 20-30 倍。BD-II 患者成功自杀的风险最高。自杀死亡的遗传率约为 40%，一些与主要神经递质系统相关的基因与自杀有关。锂是唯一显示出抗自杀潜力的治疗方法。
本综述的一个重要局限性是关于 BD 中自杀死亡的现有文献有限。
BD 患者自杀风险很高。有可能确定一些与自杀死亡相关的因素，如发病早、一级亲属中有自杀史、既往自杀未遂、共病和治疗。然而，有必要促进对这一严重健康问题的研究。
