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Mixed state and suicide: Is the effect of mixed state on suicidal behavior more than the sum of its parts?

Published on Feb 1, 2018in Bipolar Disorders 4.94
· DOI :10.1111/bdi.12538
Jane E. Persons6
Estimated H-index: 6
(UI: University of Iowa),
William Coryell85
Estimated H-index: 85
(Roy J. and Lucille A. Carver College of Medicine)
+ 3 AuthorsJess G. Fiedorowicz26
Estimated H-index: 26
Cite
Abstract
Objective To assess whether suicidal behavior during mixed states exceeds that expected from the manic or depressive components alone. Methods This study included 429 participants with bipolar disorder from the National Institute of Mental Health Collaborative Depression Study (CDS). Mood and suicidal behavior were captured using the Longitudinal Interval Follow-up Evaluation and the Schedule of Affective Disorders and Schizophrenia. Suicidal behavior during each mood state, relative to euthymia, was analyzed using Cox regression to allow for repeated events, with a frailty term to account for intra-participant correlation. Mixed states were modeled as a depression-by-mania interaction. Results Individuals with a history of mixed states were at higher risk of suicidal behavior and spent more time depressed, compared to subjects with no such history. In bipolar I disorder, risk increased during episodes of mania (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.28-2.99, P = .0019) and depression (HR: 5.49, 95% CI: 4.01-7.51, P < .0001) and there was a less than additive effect of mixed states. In bipolar II disorder, risk was increased during episodes of depression (HR: 3.66, 95% CI: 2.51-5.35, P < .0001) and there was no excess risk during mixed states beyond that attributable to the depressed component. Most of the excess risk (71%) among those with a history of mixed states was attributable to a depression predominant course of illness. Conclusions Individuals with mixed states are at high risk of suicidal behavior, largely due to more time spent depressed. Clinicians should aggressively treat depression to mitigate suicide risk for patients with or without mixed states.
  • References (32)
  • Citations (6)
Cite
References32
Newest
Published on Mar 1, 2015in Journal of Affective Disorders 4.08
In Hee Shim4
Estimated H-index: 4
,
Y.S. Woo12
Estimated H-index: 12
(Catholic University of Korea),
Won-Myong Bahk19
Estimated H-index: 19
(Catholic University of Korea)
Abstract Background We investigated the increase in the prevalence of bipolar disorder with mixed features following the replacement of DSM-IV-TR criteria with DSM-5 criteria. Additionally, we examined the clinical implications of the use of “with mixed features” as a specifier with bipolar disorder. Method We retrospectively reviewed medical charts from 2003 to 2013. A total of 331 patients diagnosed with bipolar disorder using the DSM-IV TR were enrolled and categorized into four groups: manic...
Published on Feb 1, 2015in Bipolar Disorders 4.94
Ayal Schaffer29
Estimated H-index: 29
(Sunnybrook Health Sciences Centre),
Erkki Isometsä60
Estimated H-index: 60
(UH: University of Helsinki)
+ 17 AuthorsLars Vedel Kessing50
Estimated H-index: 50
(UCPH: University of Copenhagen)
OBJECTIVES: Bipolar disorder is associated with a high risk of suicide attempts and suicide death. The main objective of the present study was to identify and quantify the demographic and clinical correlates of attempted and completed suicide in people with bipolar disorder. METHODS: Within the framework of the International Society for Bipolar Disorders Task Force on Suicide, a systematic review of articles published since 1980, characterized by the key terms bipolar disorder and 'suicide attem...
Published on Feb 1, 2015in International Journal of Epidemiology 7.34
Leila Denise Alves Ferreira Amorim15
Estimated H-index: 15
(UNC: University of North Carolina at Chapel Hill),
Jianwen Cai15
Estimated H-index: 15
(UNC: University of North Carolina at Chapel Hill)
In many biomedical studies, the event of interest can occur more than once in a participant. These events are termed recurrent events. However, the majority of analyses focus only on time to the first event, ignoring the subsequent events. Several statistical models have been proposed for analysing multiple events. In this paper we explore and illustrate several modelling techniques for analysis of recurrent time-to-event data, including conditional models for multivariate survival data (AG, PWP...
Published on Feb 1, 2015in Current Psychiatry Reports 3.82
Fernando S. Goes31
Estimated H-index: 31
(JHUSOM: Johns Hopkins University School of Medicine)
Anxiety symptoms and syndromes are common in bipolar disorders, occurring in over half of all subjects with bipolar disordertypeI.Despitemethodologicalanddiagnostic inconsistencies, most studies have shown a robust association between the presence of a broadly defined comorbid anxiety disorder and important indices of clinical morbidity in bipolar disorder, including a greater number of depressive episodes, worse treatment outcomes, and elevated risk of attempting suicide. Anxiety symptoms and/o...
Published on Jul 15, 2014in The Journal of Clinical Psychiatry 4.02
Andrew C. Leon70
Estimated H-index: 70
,
Jess G. Fiedorowicz26
Estimated H-index: 26
+ 5 AuthorsMartin B. Keller116
Estimated H-index: 116
OBJECTIVE: To examine the risk of suicidal behavior (suicide attempts and deaths) associated with antidepressants in participants with bipolar I, bipolar II, and unipolar major depressive disorders. DESIGN: A 27-year longitudinal (1981-2008) observational study of mood disorders (Research Diagnostic Criteria diagnoses based on Schedule for Affective Disorders and Schizophrenia and review of medical records) was used to evaluate antidepressants and risk for suicidal behavior. Mixed-effects logist...
Published on Aug 1, 2013in Bipolar Disorders 4.94
Maurizio Pompili53
Estimated H-index: 53
,
Xenia Gonda33
Estimated H-index: 33
(Semmelweis University)
+ 5 AuthorsPaolo Girardi47
Estimated H-index: 47
(Sapienza University of Rome)
OBJECTIVE: Suicidal behavior is a major public health problem worldwide, and its prediction and prevention represent a challenge for everyone, including clinicians. The aim of the present paper is to provide a systematic review of the existing literature on the epidemiology of completed suicides in adult patients with bipolar disorder (BD). METHODS: We performed a Pubmed/Medline, Scopus, PsycLit, PsycInfo, and Cochrane database search to identify all relevant papers published between 1980 and 20...
Published on Jun 1, 2013in Bipolar Disorders 4.94
Ahmed Akhter3
Estimated H-index: 3
(Roy J. and Lucille A. Carver College of Medicine),
Jess G. Fiedorowicz26
Estimated H-index: 26
(UI: University of Iowa)
+ 4 AuthorsWilliam Coryell85
Estimated H-index: 85
(Roy J. and Lucille A. Carver College of Medicine)
It is not clear whether a seasonal pattern exists in the psychopathology of bipolar disorder. The current literature is populated mainly with retrospective studies of admission data for individuals with discharge diagnoses of bipolar disorder. Mood episodes appear more likely to be exacerbated in the spring when analyzing hospital admissions as well as self-reported depression measures (1–3). The peak in admissions for mania has been found in the spring, summer, or both (4–6). Another retrospect...
Published on Mar 15, 2013in The Journal of Clinical Psychiatry 4.02
David A. Solomon43
Estimated H-index: 43
,
Jess G. Fiedorowicz26
Estimated H-index: 26
+ 5 AuthorsMartin B. Keller116
Estimated H-index: 116
Objectives To describe the duration of bipolar I major and minor depressive episodes and factors associated with time to recovery.
Published on Jan 1, 2013in American Journal of Psychiatry 13.65
Alan C. Swann3
Estimated H-index: 3
(Mayo Clinic),
Beny Lafer32
Estimated H-index: 32
(Mayo Clinic)
+ 6 AuthorsTrisha Suppes78
Estimated H-index: 78
(Mayo Clinic)
ObjectiveEpisodes of bipolar disorder are defined as depressive or manic, but depressive and manic symptoms can combine in the same episode. Coexistence or rapid alternation of depressive and manic symptoms in the same episode may indicate a more severe form of bipolar disorder and may pose diagnostic and treatment challenges. However, definitions of mixed states, especially those with prominent depression, are not well established.MethodThe authors performed literature searches for bipolar diso...
Published on Sep 1, 2012in Bipolar Disorders 4.94
Jess G. Fiedorowicz26
Estimated H-index: 26
(UI: University of Iowa),
Jean Endicott93
Estimated H-index: 93
(Columbia University)
+ 2 AuthorsWilliam Coryell85
Estimated H-index: 85
The onset of a new hypomanic or manic (H/M) episode warrants a change in diagnosis from unipolar major depression to bipolar disorder. The duration of episodes and concurrent treatments are considered to have nosological relevance though there has been limited empirical study to inform contemporary diagnostic nomenclature. Are such episodes equivalent to those that develop without antidepressant provocation in indicating a lifetime bipolar diathesis? Does duration of the H/M episode matter? Are ...
Cited By6
Newest
Published on Jun 1, 2019in Journal of Affective Disorders 4.08
Romain Icick4
Estimated H-index: 4
,
Ingrid Melle61
Estimated H-index: 61
(University of Oslo)
+ 9 AuthorsOle A. Andreassen73
Estimated H-index: 73
(University of Oslo)
Abstract Background Suicide attempts (SA) are more frequent in bipolar disorder (BD) than in most other mental disorders. Prevention strategies would benefit from identifying the risk factors of SA recurrence in BD. Substance use disorders (SUD) (including tobacco-related) are strongly associated with both BD and SA, however, their specific role for the recurrence of SA in BD remains inadequately investigated. Thus, we tested if tobacco smoking - with or without other SUDs – was independently as...
Published on Jul 19, 2019in Medicina-buenos Aires 0.53
G. Fico2
Estimated H-index: 2
,
Vito Caivano + 5 AuthorsAndrea Fiorillo26
Estimated H-index: 26
Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperaments are associated with suicidal risk, but their predictive role is still understudied. The aim of this study is to assess the relationship between affective temperaments and personal history of violent su...
Published on Mar 21, 2019in Australian and New Zealand Journal of Psychiatry 5.00
Ayal Schaffer29
Estimated H-index: 29
(U of T: University of Toronto),
Mark Sinyor14
Estimated H-index: 14
(U of T: University of Toronto)
Published on Mar 1, 2019in Journal of Affective Disorders 4.08
Jess G. Fiedorowicz26
Estimated H-index: 26
(UI: University of Iowa),
Jane E. Persons6
Estimated H-index: 6
(Roy J. and Lucille A. Carver College of Medicine)
+ 6 AuthorsWilliam Coryell85
Estimated H-index: 85
(Roy J. and Lucille A. Carver College of Medicine)
A bstract Objectives To determine whether the risk of suicidal ideation or behavior during mixed states exceeds that attributable to the depressive components of these states alone in bipolar disorder. Methods We utilized real-world, longitudinal clinical data collected on 290 patients with bipolar disorders (bipolar I, bipolar II, and bipolar not otherwise specified (NOS)) from the National Network of Depression Centers (NNDC) Clinical Care Registry (CCR) seen for 891 visits over a mean of 27.5...
Published on Oct 17, 2018in Psychological Medicine 5.64
Ji Hyun Baek13
Estimated H-index: 13
(SKKU: Sungkyunkwan University),
Kyooseob Ha25
Estimated H-index: 25
+ 7 AuthorsKyung Sue Hong14
Estimated H-index: 14
(SKKU: Sungkyunkwan University)
Published on Oct 1, 2018in Psychiatry Research-neuroimaging 2.21
Taiane de Azevedo Cardoso11
Estimated H-index: 11
(UCPel: Universidade Católica de Pelotas),
Thaíse Campos Mondin8
Estimated H-index: 8
(UCPel: Universidade Católica de Pelotas)
+ 2 AuthorsLuciano Dias de Mattos Souza18
Estimated H-index: 18
(UCPel: Universidade Católica de Pelotas)
Abstract To assess predictors of the diagnosis of bipolar disorder is important since it is known that the early diagnosis is associated with a better response to the treatment. Thus, the aim of this systematic review is to assess the role of the suicide risk in the diagnosis conversion to bipolar disorder. We searched Pubmed, Bireme, Scopus, and PsycINFO with no year restriction for articles containing the words (suicidal or suicide or suicide risk or suicide attempt) and (conversion or switch)...
Published on Sep 1, 2018in Acta Psychiatrica Scandinavica 4.69
Leonardo Tondo53
Estimated H-index: 53
(Harvard University),
Gustavo H. Vázquez4
Estimated H-index: 4
(Queen's University)
+ 2 AuthorsRoss J. Baldessarini99
Estimated H-index: 99
(Harvard University)