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Titre du document / Document title

Suicidal events and accidents in 216 first-episode bipolar I disorder patients : Predictive factors

Auteur(s) / Author(s)

KHALSA Hari Mandir Kaur (1) ; SALVATORE Paola (1 2) ; HENNEN John (1) ; BAETHGE Christopher (1 3) ; TOHEN Mauricio (1 4) ; BALDESSARINI Ross J. (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Psychiatry, Harvard Medical School and the International Consortium for Bipolar Disorder Research, Mailman Research Center, McLean Division of Massachusetts General Hospital, Belmont, MA 02478, ETATS-UNIS
(2) Section of Psychiatry, Department of Neuroscience, University of Parma, ITALIE
(3) Department of Psychiatry, University of Cologne Medical School, Cologne, ALLEMAGNE
(4) Lilly Research Laboratories, Indianapolis, IN, ETATS-UNIS

Résumé / Abstract

Background: Risks of life-threatening behaviors are high among bipolar disorder (BPD) patients, but early rates and associated risk factors for suicides and accidents remain ill-defined. Methods: We assessed 216 DSM-IV BP-I patients prospectively for 4.2 years from first-lifetime hospitalization, using ordinal logistic-regression to estimate risks and associated demographic and clinical factors among risk-groups with: [1] no suicidal ideation, acts, or accidents, [2] suicidal ideation only, [3] suicides and attempts, [4] accidents, and [5] both suicidal acts and accidents. Results: Suicidal thoughts or acts were identified in 127/216 subjects/4.2 years (14%/year), including suicidal ideation in 88 (9.7%/year), and acts in 39 (4.3%/year: 38 attempts [17.6%/year], 1 suicide [0.11%/year]); 87% of acts occurred within a year of a first-episode. Life-threatening accidents occurred in 20 cases (2.2%/year) with a mean latency of 3.8 years, including 12 with suicidal ideation or attempts (60% co-occurrence of accidents and suicidality); alcohol was implicated in 25% of accidents. The 53 cases of violent behaviors (5.84%/year) included a fatal car-wreck and a suicide, for a mortality risk of 0.22%/year (2/216/4.2 years). Suicidality was associated with initial mixed-state, proportion of follow-up weeks in mixed-states or depression, and prior suicide attempts; accidents were associated selectively with initial mania or psychosis, later mania or hypomania, and alcohol abuse. Violent acts also were associated with use of more psychotropic medicines/person, and with use of antipsychotics or sedative-anxiolytics. Limitations: Treatment was clinical and uncontrolled, illness relatively severe, and statistical power limited. Conclusions: Early in BP-I disorder, risks of suicidal acts and accidents were high, inter-related, and associated with particular types of initial and later morbidity, suggesting some predictability and potential for preventive intervention.

Revue / Journal Title

Journal of affective disorders    ISSN  0165-0327   CODEN JADID7 

Source / Source

2008, vol. 106, no1-2, pp. 179-184 [6 page(s) (article)] (1/2 p.)

Langue / Language

Anglais

Editeur / Publisher

Elsevier, Oxford, ROYAUME-UNI  (1979) (Revue)

Mots-clés anglais / English Keywords

Mood disorder

;

Risk factor

;

Bipolar disorder

;

Predictive factor

;

First episode

;

Accident

;

Suicide

;

Mots-clés français / French Keywords

Trouble de l'humeur

;

Trouble bipolaire type I

;

Facteur risque

;

Trouble bipolaire

;

Facteur prédictif

;

Premier épisode

;

Accident

;

Suicide

;

Mots-clés espagnols / Spanish Keywords

Trastorno humor

;

Factor riesgo

;

Trastorno bipolar

;

Factor predictivo

;

Primer episodio

;

Accidente

;

Suicidio

;

Mots-clés d'auteur / Author Keywords

Bipolar disorder

;

First-episode

;

Risk factors

;

Suicide

;

Accidents

;

Localisation / Location

INIST-CNRS, Cote INIST : 18006, 35400018345810.0190

Nº notice refdoc (ud4) : 20044063



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