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BP TODAY - A team of French scientists have identified 8 risk factors associated with lifetime suicide attempts of bipolar patients from a France national cohort.

Risk factors that may be associated with suicide attempts in bipolar disorder are still a matter of debate. The researchers compared demographic, illness course, clinical, and temperamental features of suicide attempters vs those of nonattempters in a large sample of bipolar I patients admitted for an index manic episode.

The research was carried out at the Department of Psychiatry of the Sainte Marguerite Hospital in France.

1090 patients (attempters = 382, nonattempters = 708) were included in the study.

Multivariate analysis evidenced 8 risk factors associated with lifetime suicide attempts as follows:

1. multiple hospitalization
2. depressive or mixed polarity of first episode
3. presence of stressful life events before illness onset
4. younger age at onset
5. no free intervals between episodes
6. female sex
7. higher number of previous episodes
8. cyclothymic temperament

What is Cyclothymic Personality Disorder? Cyclothymic Personality Disorder is a pervasive pattern of pronounced periodic changes in mood, behavior, thinking, sleep, and energy levels, beginning by early adulthood and present in a variety of contexts, as indicated by seven (or more) of the following:

• has depressive periods: depressed mood or loss of interest or pleasure in all, or almost all, activities and pastimes alternating with hypomanic periods: elevated, expansive, or irritable mood (American Psychiatric Association, 1980, pg. 220);
• becomes excessively involved in pleasurable activities with lack of concern for the high potential of painful consequences alternating with restriction of involvement in pleasurable activities and guilt over past activities (pg. 220);
• alternates between over-optimism or exaggeration of past achievement and a pessimistic attitude toward the future, or brooding about past events (pg. 220);
• is more talkative than usual, with inappropriate laughing, joking, and punning: and, then, less talkative, with tearfulness or crying (pg. 220);
• has a decreased need for sleep alternating with hypersomnia (Akiskal, Khani, and Scott-Strauss qtd. in Jamison, pg. 264); 1
• has shaky self-esteem: naive grandiose overconfidence alternating with lack of self-confidence (pg. 264);
• has periods of sharpened and creative thinking alternating with periods of mental confusion and apathy (pg. 264);
• displays marked unevenness in the quantity and quality of productivity, often associated with unusual working hours (pg. 264);
• engages in uninhibited people-seeking (that may lead to hyper-sexuality) alternating with introverted self-absorption (pg. 264);
• frequently shifts line of work, study, interest, or future plans (pg. 264);
• engages in occasional financial extravagance (pg. 264);
• has a tendency toward promiscuity, with repeated conjugal or romantic failure (pg. 264);
• may use alcohol or drugs to control moods or to augment excitement (pg. 264);
• has irritable-angry-explosive outbursts that alienate loved ones (pg. 264);
• makes frequent changes in residence or geographical location (Akiskal, 1995, pg. 1143).

These characteristics may help identify subjects at risk for suicide attempt throughout the course of bipolar disorder. The scientists propose to integrate such characteristics into a stress-diathesis model of suicidal behaviour, adapted to bipolar patients.

[Compr Psychiatry. 2009 March - April;50(2):115-120. Epub 2008 Sep 20.]

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