Apr 19, · Background: Bipolar disorder (BD) is the 10th most common cause of frailty in young individuals and has triggered morbidity and mortality worldwide. Patients with BD have a life expectancy 9 to 17 years lower than that of normal people. BD is a predominant mental disorder, but it can be misdiagnosed as depressive disorder, which leads to difficulties in treating affected patients Sep 09, · Does the body make and keep its own circadian rhythms? Yes, natural factors in your body produce circadian rhythms. For humans, some of the most important genes in this process are the Period and Cryptochrome genes. These genes code for proteins that build up in the cell’s nucleus at night and lessen during the day.. Studies in fruit flies suggest that these proteins help activate feelings The linguistic origins of mania in relation to bipolar disorder. The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ""ania", meaning to produce great mental anguish, and "manos", meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or
Suicide Risk in Bipolar Disorder: A Brief Review
Try out PMC Labs and tell us what you think. Learn More. One of the contributors for the decreased life expectancy in BD is suicide. Accordingly, the rate of suicide among BD patients is approximately 10—30 times higher than the corresponding rate in the general population.
In our paper we briefly recapitulate the current knowledge on the epidemiological aspects of suicide in BD as well as factors associated with suicidal risk in BD. Furthermore, we also discuss concisely the possible means of suicide prevention in BD. With a lifetime prevalence of 1. Patients with BD have poor life expectancies as these patients have a decreased lifespan of about 9—17 years compared with the general population.
Furthermore, some studies from different countries e. Although the largest number of excess death cases in BD may be attributed to natural e. At a global scale, approximatelysuicide deaths occur every year which corresponds to a global suicide rate of Accordingly, in addition to major mood disorders, other risk factors including special clinical features of the mental illness as well as some demographic, personality and familial factors should contribute to suicidality, which therefore should be deemed as a multicausal phenomenon [ 28910 ].
Hereinafter, we provide a concise summary of our current knowledge about suicidality in BD based on research paper on bipolar disorder review of current literature mainly review papers, book chapters, meta-analyses, treatment guidelines of international societies, etc. In BD, the risk of suicide death is up to 10—30 times higher than that of the general population [ 25810research paper on bipolar disorder, 1112 ].
It is important to mention that the ratio of suicide attempts to suicide deaths i. A possible explanation for this phenomenon may be that BD subjects usually employ more lethal suicide methods compared with members of the general population [ 28research paper on bipolar disorder, 9 ].
Nevertheless, attempts-to-suicide ratios lower than in the general population are not specific for BD, as it is also observable for instance among patients with schizophrenia or major depressive disorder MDD [ 2research paper on bipolar disorder, 14 ]. Though it is indisputable that mood disorders are associated with markedly elevated levels of suicidality, it is hard to pick out from the results of various studies whether there are relevant differences in the risk of suicidal behaviour between different kinds of mood disorders.
Accordingly, higher, similar or lower levels of suicidality in BD patients compared to MDD patients have also been reported [ 91016 ]. In a similar fashion, based on the published information it is hard to disentangle whether any BD subtype BD-I or BD-II is associated with a higher level of suicidality than the other [ 281116171819 ].
This so called subthreshold bipolar subgroup of MDD patients differs from MDD patients without subthreshold hypomanic manifestations in several ways. For instance, a wide array of studies demonstrated that subthreshold bipolarity is associated with increased levels of suicidality [ 20212223 ].
Several approaches exist to classify risk factors for suicide in BD. One of the most common systems divides risk factors into proximal and distal ones, where proximal or precipitating factors are close to suicidal behaviour in time whereas distal factors are rather considered as traits or predispositions and, accordingly, they are enduring [ 1024 ]. Other classifications assign suicide risk factors to conceptual categories e.
Based on different conceptual backgrounds complex models were conceived for the description of the whole process of suicide e. In the current paper—without the ambition to be exhaustive—we list and briefly discuss the most relevant risk and protective factors of suicide in BD.
In regard to clinical historyprevious suicide attempt s is considered as one of the most powerful single predictors of future attempts and suicide death. The period soon after hospital discharge may be characterized by extremely high levels of suicidality.
This finding draws attention to the importance of avoiding premature discharges and inappropriate follow-ups. In addition, risk of suicide is increased during the period immediately after hospital research paper on bipolar disorder. Early age at onset is also associated with suicidality in BD. The early years after the diagnosis represent a high-risk period for suicide.
Comorbidity with other psychiatric, addictive or severe somatic disorders also increase the risk of all forms of suicidal behaviour. Rapid-cycling course and predominant depressive polarity during the prior course are also associated with higher risks of self-destructive behaviour. However, some recent results indicated that there is no elevated risk of suicidal behaviour during mixed state over the risk attributable to its depressed component.
Furthermore, these studies suggest that the majority of suicide risk elevation related to having previous mixed states is not an aftermath of the mixed state itself, but can rather be attributed to a depression-predominant course of the disorder. Longer duration of untreated illness i. Regarding sociodemographic factorsmale gender is a risk factor for lethal suicides, while, according to some results, female gender is a risk factor for attempts.
These gender differences are similar—but weaker—to those observable in the general population; accordingly, in this otherwise high-risk population gender seems not to be a significant predictor for suicidal behaviour. Suicidality is also more frequent among those bipolar subjects who are divorcedunmarried or single-parents or living research paper on bipolar disorder social isolation.
Age is a further important sociodemographic factor: BD subjects under 35 years of age and above 75 years of age are at higher risk for engaging in suicide-related behaviours. Occupational problems and unemployment also contribute to elevated levels of suicidality.
Certain types of affective temperaments first and foremost cyclothymic have also been demonstrated to be associated with more frequent suicidal behaviour in BD.
Some results also suggest that living in geographical locations where there are large differences in solar insolation between winter and summer i. In contrast to the above discussed several risk factors for suicide in BD, only a few protective factors have been identified so far [ 2 ]. For instance good family and social supportparenthood and the use of adaptive coping strategies seem to have some protective effects.
Furthermore, a strong perceived research paper on bipolar disorder of life and hyperthymic affective temperament are also a protective factors [ 2102429 ]. The possible protective role of religiosity has emerged but results are somewhat inconclusive [ 226353637 ]. In consonance with the fact that treatment may decrease heightened suicidality, it is not surprising that the majority of suicide victims are untreated affective disorder patients [ 891011133839 ].
From a pharmacological perspectivelithium seems to possess the greatest suicide-preventive potential in patients with BD. This finding may suggest that in the case of lithium non-response in a patient who is at high risk for suicide, instead of switching lithium to another mood stabilizer, research paper on bipolar disorder, the clinician should retain lithium research paper on bipolar disorder in a lower dose and combine it with another mood stabilizer [ 141 ].
A solid suicide-protective effect related to the administration of anticonvulsant-type mood stabilizers e. On the other hand, the concern of the FDA about the potential for an increased risk of suicidality associated with anticonvulsants seems not to be applicable to patients with BD i. According to our current knowledge, in regard to suicide prevention lithium is superior than these agents [ 28research paper on bipolar disorder, 15414344 ]. The role of antidepressants ADs in suicide prevention in research paper on bipolar disorder with BD seems to be negligible, and, in fact, concerns have been raised that administration of ADs may increase suicidality in BD.
It is remarkable that findings are also inconsistent regarding the ability of ADs to prevent suicides in patients with MDD. AD monotherapy should be avoided in BD [ 281541 ]. Considering their increasing use in BD for instance as maintenance treatment, it is justifiable to ask whether atypical antipsychotics have any beneficial effects on suicidal behaviour in BD.
Unfortunately, there are no high-quality data to answer this question at present, so further studies should elucidate whether treatment with antipsychotics has any benefits in this respect [ 281541 ].
Ketamin as a possible antidepressant agent has mainly been tested in patients with MDD and only a few research paper on bipolar disorder have been conducted among patients with bipolar depression. According to the results of these small proof-of-concept investigations, ketamin shows similar antidepressive efficacy in bipolar as in unipolar depression. In line with its possible efficacy, ketamin is recommended by the clinical guideline of International College of Neuropsychopharmacology CINP for the treatment of bipolar depression, but only as a fourth-line agent and in combination with a mood stabilizer.
Similarly, until now, the antisuicidal activity of ketamine was assessed mainly in MDD patients and only a small number of investigations have been conducted in BD patients. These have mainly positive outcomes, but further studies are needed to research paper on bipolar disorder whether ketamin has a similar antisuicidal effect in BD than in MDD [ 45464748495051 ]. It is well-known that electroconvulsive therapy ECT shows a similar efficacy in the treatment of depressive episodes in MDD and BPD and some studies even found it more effective against bipolar than unipolar depression.
In line with its antidepressive effects, Research paper on bipolar disorder is also considered as an effective antisuicidal treatment modality, and it has been recently demonstrated that it is superior in this regard to psychopharmacons both in unipolar and bipolar depression and its antisuicidal efficacy is comparable to the efficacy of psychopharmacons in bipolar mixed states and mania [ 28415253 ].
Unfortunately, only a small number of studies have investigated up to now the efficacy of specific e. Nonetheless, results of the few existing studies are promising [ 285455565758 ]. BD is a relatively common psychiatric disorder that is associated with increased mortality due to both natural and unnatural causes. Accordingly, the risk of suicide is highly elevated in this patient population.
Because of this, a thorough assessment of suicide risk should take place at all clinical visits. This clinical assessment should include, inter aliathe comprehensive examination of the mental state, and the inquiry about the existence and features of current suicidal intents e.
In addition, it is essential to gain information about previous suicidality. Whenever possible, hetero-anamnestic data should be gathered as well. The management of suicidal behaviour in patients with BD represents a clinical challenge. Appropriate long-term treatment of the disorder seems to be associated with the reduction of suicidality, research paper on bipolar disorder. Furthermore, in acutely suicidal patients the removal of access to obvious means for suicide is essential and, in severe cases, hospitalization may be justifiable as well, research paper on bipolar disorder.
A written list of sources of support which are available during a suicidal crisis may also be helpful [ 2101559 ]. National Research paper on bipolar disorder for Biotechnology InformationU. National Library of Medicine Rockville PikeBethesda MDUSA.
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Journal List Medicina Kaunas v. Medicina Kaunas. Published online Jul doi: PMCID: PMC Peter Dome 1 Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, research paper on bipolar disorder, Hungary 2 National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Budapest, Hungary Find articles by Peter Dome.
Zoltan Rihmer 1 Department of Psychiatry and Psychotherapy, Semmelweis University, research paper on bipolar disorder, Faculty of Medicine, Budapest, Hungary 2 National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Budapest, Hungary Find articles by Zoltan Rihmer. Xenia Gonda 1 Department of Psychiatry and Psychotherapy, Semmelweis University, Faculty of Medicine, Budapest, Hungary 2 National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Budapest, Hungary 3 MTA-SE Neuropsychopharmacology, Neurochemistry Research Group, Hungarian Academy of Sciences, Budapest, Hungary 4 NAPSE New Antidepressant Target Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary Find articles by Xenia Gonda.
Author information Article notes Copyright and License information Disclaimer. Received Jun 19; Accepted Jul Copyright © by the authors. Licensee MDPI, Basel, Switzerland. This article has been cited by other articles in PMC.
Keywords: bipolar disorder, mood disorders, suicide, suicidal, mortality. Introduction With a lifetime prevalence of 1.
Scientific Insights Into Bipolar Disorder
, time: 7:45Mental Health, Creativity, and Wealth | NBER
The linguistic origins of mania in relation to bipolar disorder. The linguistic origins of mania, however, are not so clear-cut. Several etymologies are proposed by the Roman physician Caelius Aurelianus, including the Greek word ""ania", meaning to produce great mental anguish, and "manos", meaning relaxed or loose, which would contextually approximate to an excessive relaxing of the mind or Apr 19, · Background: Bipolar disorder (BD) is the 10th most common cause of frailty in young individuals and has triggered morbidity and mortality worldwide. Patients with BD have a life expectancy 9 to 17 years lower than that of normal people. BD is a predominant mental disorder, but it can be misdiagnosed as depressive disorder, which leads to difficulties in treating affected patients Focusing on bipolar disorder (BD), we investigate the link between mental health, creativity, and wealth. Analyzing population data for Denmark, we find that people with BD are more likely to be musicians, but less likely to hold other creative jobs than the population
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