Bipolar disorders are quite prevalent, but frequently underreferred, underdiganosed and undertreated illnesses. The early recognition and appropriate treatment is particularly important, since untreated bipolar disorders carry extremely high risk of both attempted and committed suicide. Recent studies clearly show that suicidal behaviour in patients with bipolar disorders is state and severity dependent that means that suicidality markedly decreases or vanishes after clinical recovery from major depressive episode or from dysphoric mania. However, since the majority of bipolar patients never committ and around half of them never attempt suicide, special clinical characteristics of the illness as well as some familial and psycho-social factors should also play a contributory role. Considering the clinically explorable suicide risk factors in patients with bipolar disorders (family and/or personal hisotry of suicidal behaviour, early onset, severe depressive episode/hopelessness, agitated/mixed depression, bipolar II diagnosis, rapid cyling course, dysphoric mania, mixed affective episode, comorbid Axis I and Axis II disorders, adverse life situations, lack of social and medical support), in the majority of cases, suicidal behaviour is predictable with a good chance. There are also several evidences that (succesful) acute and long-term treatment of bipolar patients (with mood stabilizers and with antidepressants/antipsychotics) substantially reduces the risk of attempted and completed suicide, even in this high-risk population. Supplementary psycho-social interventions (psychoeducation, targeted psychotherapies) further improve the results.
This post was submitted by Prof Zoltan Rihmer.
