Be'er Yaakov mental health center and Tel Aviv University, Tel Aviv, Israel.
The Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, USA; Harvard Medical School, 50 Staniford Street, Suite 580, Boston, MA, USA.
J Affect Disord. 2021 Mar 1;282:1241-1246. doi: 10.1016/j.jad.2020.12.184. Epub 2020 Dec 31.
Psychotic symptoms during bipolar depressive episodes, especially in outpatients, are under recognized and studied by clinicians and researchers. We examined the relationship between psychotic symptoms during a depressive episode and suicidal ideation in bipolar patients.
Participants (N = 351) were adult, depressed outpatients with bipolar disorder (BD) in a comparative effectiveness study of quetiapine versus lithium. Psychotic symptoms were assessed via Bipolar Inventory of Signs and Symptoms Scale (BISS) and depressive episodes via Mini-International Neuropsychiatric Interview (MINI). Because only 4.84% (N = 17) endorsed psychotic symptoms, we performed iterative multivariate matching with non-psychotic participants. On every matched population, a multiple regression analysis examined whether psychotic symptoms were associated with suicidal ideation, via the Concise Health Risk Taking scale (CHRT-12).
Averaged across the 50 matched populations, current psychotic symptoms predicted active suicidal ideation on the CHRT, but not a passive propensity toward suicide or total CHRT scores, after adjusting for common correlates of suicidality (e.g., previous suicidal behavior) (β=0.59, p=.01, R2= 0.41).
Our study was limited by three factors. First, the generalizability of our study was limited as the sample included only outpatients. Next, the analysis was cross-sectional and does not allow for causal interpretation. Lastly, our study lacked information regarding the content and mood congruency of participants' psychosis.
While a small proportion of BD outpatients had current symptoms of psychosis during their depressive episode, those who did were more likely to endorse active suicidal thoughts, including suicide methods and plans.
躁狂症抑郁发作期间的精神病症状，尤其是在门诊患者中，被临床医生和研究人员所忽视和研究。我们研究了躁狂症患者抑郁发作期间精神病症状与自杀意念之间的关系。
参与者（N=351）为在一项喹硫平与锂盐治疗双相情感障碍的对照有效性研究中患有双相情感障碍的成年、抑郁门诊患者。精神病症状通过双相情感障碍症状清单（BISS）评估，抑郁发作通过迷你国际神经精神访谈（MINI）评估。由于只有 4.84%（N=17）的患者报告有精神病症状，因此我们对非精神病患者进行了迭代多变量匹配。在每个匹配的人群中，通过简明健康风险行为量表（CHRT-12）进行多元回归分析，以确定精神病症状是否与自杀意念有关。
在 50 个匹配人群的平均值中，在调整自杀倾向的常见相关因素（如既往自杀行为）后，当前的精神病症状可预测 CHRT 上的主动自杀意念，但不能预测被动自杀倾向或总 CHRT 评分（β=0.59，p=.01，R2=0.41）。
我们的研究受到三个因素的限制。首先，由于样本仅包括门诊患者，因此我们的研究的普遍性受到限制。其次，分析是横断面的，不允许进行因果解释。最后，我们的研究缺乏关于参与者精神病内容和情绪一致性的信息。
尽管只有一小部分双相情感障碍门诊患者在其抑郁发作期间出现当前的精神病症状，但这些患者更有可能出现主动自杀意念，包括自杀方法和计划。
