Lage Renata Reis, Santana Cristina M T, Nardi Antonio Egidio, Cheniaux Elie
Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Trends Psychiatry Psychother. 2019 Jul 10;41(2):191-200. doi: 10.1590/2237-6089-2018-0042.
The objective of this study was to identify whether mixed states in bipolar disorder (BD) are associated with more frequent suicidal behavior when compared to manic/hypomanic and depressive episodes.
We performed a systematic search of the scientific literature on the subject using the PubMed, ISI Web Of Science, PsycINFO and SciELO databases. The terms chosen for the search were (bipolar) AND (suicid*) AND (mixed). We selected original studies comparing suicidal behavior of patients in mixed states and suicidal behavior of patients in other BD phases.
Sixteen papers fit the selection criteria. Twelve of the original 16 studies compared suicidal behavior in mixed states and pure mania, and the majority of these studies (n = 11) revealed that suicidal behavior was more frequent among individuals in mixed states. Five of the papers compared suicidal behavior between depressive and mixed phases of BD. One of these five papers reported more severe suicidal behavior in patients in mixed states and another described more frequent suicidal behavior in patients with pure depression. There were no significant statistical differences between groups in the remaining three of these five studies.
During acute BD episodes, suicidal behavior is more strongly associated with mixed states than with pure mania or hypomania. However, it was not possible to demonstrate that the association between suicidal behavior and mixed states is stronger than the association between suicidal behavior and depressive phases. The results hereby presented are worth considering in clinical practice to better evaluate suicide risk and to prevent suicide.
本研究的目的是确定双相情感障碍（BD）的混合状态与躁狂/轻躁狂发作及抑郁发作相比，是否与更频繁的自杀行为相关。
我们使用PubMed、ISI科学网、PsycINFO和SciELO数据库对该主题的科学文献进行了系统检索。检索所选的术语为（双相情感障碍） AND （自杀*） AND （混合）。我们选择了比较混合状态患者自杀行为与双相情感障碍其他阶段患者自杀行为的原始研究。
16篇论文符合入选标准。最初的16项研究中有12项比较了混合状态和单纯躁狂状态下的自杀行为，其中大多数研究（n = 11）表明混合状态下个体的自杀行为更为频繁。有5篇论文比较了双相情感障碍抑郁期和混合期的自杀行为。这5篇论文中的1篇报告混合状态患者的自杀行为更严重，另一篇描述单纯抑郁患者的自杀行为更频繁。在这5项研究中的其余3项研究中，两组之间没有显著的统计学差异。
在双相情感障碍急性发作期间，自杀行为与混合状态的关联比与单纯躁狂或轻躁狂的关联更强。然而，无法证明自杀行为与混合状态之间的关联比自杀行为与抑郁期之间的关联更强。本文给出的结果在临床实践中值得考虑，以便更好地评估自杀风险并预防自杀。
