Assessment of suicidal behavior in bipolar disorder

Year 2019, Volume: 44 Issue: 2, 659 - 668, 30.06.2019

Kerim Uğur Lut Tamam , Nurgül Özpoyraz Mehmet Emin Demirkol

https://doi.org/10.17826/cumj.503328

Cited By: 1

Abstract

Purpose: In this study, the relationship between suicidal behavior and sociodemographic, clinical characteristics, impulsivity and childhood traumas of patients were investigated in bipolar disorder. The study sample was composed of patients with bipolar disorder who were followed in the Bipolar Disorder Unit.

Material and Methods: The study included 91 patients who were admitted to our outpatient clinic with the diagnosis of Bipolar Disorder. The study data were collected by using the Mood Disorders Form, SCID-I, SCID-II, Young Mania Rating Scale, Hamilton Depression Rating Scale, Suicide Behavior Scale, Childhood Trauma Questionnaire and Barratt Impulsivity Scale. All diagnostic procedures and interviews were performed by the same psychiatrist.

Results:  Of the 91 patients included in the study, 52 were female and 39 were male. There were history of suicide attempt in 40 of 91 bipolar disorder patients. In the group attempting suicide, the depressive and mixed episodes were more often and the functionality was partially affected during the inter-episode period and the frequency of psychotic features was higher. In addition, we could not find any statistically significant relationship between the two groups for childhood trauma and impulsivity.

Conclusion: Bipolar Disorder is a lifelong disease that significantly disrupts functionality. Bipolar disorder is associated with high rates of suicide attempt and completed suicide. In this respect, the investigation of sociodemographic, clinical and other variables among patients with suicidal behavior and the detection of possible risk factors will be effective in preventing possible suicidal behavior.

Keywords

Bipolar disorder, suicidal behavior, childhood trauma, impulsivity

Bipolar bozuklukta özkıyım davranışlarının değerlendirilmesi

Abstract

Amaç: Bu çalışmada düzenli olarak Bipolar Bozukluk tanısıyla izlenen hastalarda özkıyım davranışının, hastaların sosyodemografik ve klinik özellikleri, dürtüsellik ve çocukluk çağı travmaları ile ilişkisi araştırılmıştır.

Gereç ve Yöntem: Çalışmaya polikliniğimize başvuran Bipolar Bozukluk tanısıyla izlenen 91 hasta dahil edilmiştir. Çalışma verileri tarafımızca oluşturulan Duygudurum Bozuklukları Hasta Kayıt Formu, SCID-I, SCID-II, Young Mani Değerlendirme Ölçeği, Hamilton Depresyon Değerlendirme Ölçeği, Özkıyım Davranışı Ölçeği, Çocukluk Çağı Travmaları Ölçeği ve Barratt Dürtüsellik Ölçeği kullanılarak toplanmıştır. Tüm tanısal işlemler ve görüşmeler aynı psikiyatrist tarafından yapılmıştır.

Bulgular:Çalışmaya dahil edilen 91 hastanın 52’si kadın, 39’u erkekti. Çalışmamızda 91 bipolar bozukluk hastasının 40’ında özkıyım girişimi öyküsü vardı. Özkıyım girişiminde bulunan grupta hastalık sürecinin daha çok depresif ve karma ataklarla seyrettiği, ataklar arası dönemde işlevselliğin kısmi etkilenmiş olduğunu ve psikotik özellikli daha ağır atak sıklığının daha fazla olduğunu bulduk. Bunun yanında iki grup arasında çocukluk çağı travmaları ve dürtüsellik için istatiksel olarak anlamlı ilişki bulamadık.

Sonuç:Bipolar Bozukluk yaşam boyu süren ve işlevselliği büyük oranda bozan bir hastalıktır. Bipolar bozukluk yüksek oranlarda özkıyım girişimi ve tamamlanmış özkıyım ile ilişkilidir. Bu açıdan özkıyım davranışında bulunan hastalarla bulunmayan hastalar arasındaki sosyodemografik, klinik ve diğer değişkenlerin araştırılması ve olası risk faktörlerinin tespiti hastalarda gelişebilecek olası özkıyım davranışını önlemede etkili olacaktır.

Keywords

Bipolar bozukluk, özkıyım davranışı, çocukluk çağı travmaları, dürtüsellik

References

• Sadock BJ, Sadock VA, Kaplan & Sadock Comphensive Textbook of Psychiatry, 8. Baskı, Ankara: Güneş Kitabevi, 2007.
• Jamison KR et al. Suicide and bipolar disorder. J Clin Psychiatry. 2000;61:47–51.
• Swann C, Donald M, Peggy J. Increased impulsivity associated with severity of suicide attemp history in patients with bipolar disorder. Am J Psychiatry. 2005;162:1680-7.
• Simon TR, Swann AC, Powell KE, Potter LB, Kresnow M et al. Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav. 2001;32(suppl 1):30–41.
• Soares JC. Recent advences in the treatment of bipolar mania, depression, mixed states and rapid cycling. Int Clin Psychopharmacol. 2000;15:183-96.
• Oquendo MA, Waternaux C, Brodsky B, Parsons B, Haas GL, Malone KM et al. Suicidal behavior in bipolar mood disorder clinical characteristics of attempers and non attempers. J Affeft Diord. 2000;59:110-7.
• Swann AC, Koslow SH, Katz MM, Maas JW, Javaid J, Secunda SK et al. Lithium carbonate treatment of mania: cerebrospinal fluid and urinary monoamine metabolites and treatmentoutcome. Arch Gen Psychiatry. 1987;44:345-54.
• Mann JJ, Waternaux C, Haas GL, Malone KM. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry. 1999;156:181-9.
• Murphy GE, Wetzel RD, Robins E, McEvoy L. Multiple risk factors predict suicide in alcholism. Arch Gen Psychiatry. 1992;49:459-63.
• Frances A, Fyrer M, Clarkin J. Personality and suicide. Ann NY Acad Sci. 1986; 281-93.
• Sar V, Taycan O, Bolat N, Ozmen M, Duran A, Ozturk E et al. Childhood trauma and dissociation in schizophrenia. Psychopathology. 2010;43(1):33-40.
• Sar V, Islam S, Ozturk E. Childhood emotional abuse and dissociation in patients with conversion symptoms. Psychi at Clin Neurosci. 2009;63(5):670-7.
• Thombs BD, Bernste in DP, Lobbes ta el J, Arntz A. A validation study of the Dutch Childhood Trauma Questionnaire-Short Form: factor structure, reliability, and known-groups validity. Child Abuse Negl. 2009;33(8):518-23.
• Corruble E, Damy C, Guelfi JD. Impulsivity: a relevant dimension in depression regarding suicide attempts? J Affect Disord. 1999;53:211-5.
• Swann AC, Moeller FG, Steinberg JL, Schneider L, Barratt ES et al. Manic symptoms and impulsivity during bipolar depressive episodes. Bipolar Disord. 2007;9:206-12.
• Young RC, Biggs JT, Ziegler VE, Meyer DA. A rating scale for mania: reability, validity and sensivity. The British Journal of Psychiatry. 1978;133(5):429-35.
• Karadağ F, Oral ET, Yalçın FA, Erten E. Young mani derecelendirme ölçeğinin Türkiye’de geçerlilik ve güvenilirliği. Türk Psikiyatri Dergisi. 2001;13(2):107-14.
• Hamilton MA. Rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56-62.
• Akdemir A, Türkçapar HM. Hamilton depresyon derecelendirme ölçeğinin geçerliliği, güvenilirliği ve klinikte kullanımı. Psikiyatri, Psikoloji, Psikofarmakoloji (3P) Dergisi. 1996;4: 251-9.
• Ventura J, Liberman RP, Green MF, Shaner A, Mintz J. Training and quality assurance with the Structured Clinical Interview for DSM-IV( SCID-1/P). Psychiatry Res. 1998;79:163-73.
• Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM-IV (SCID-I) Turkce Formu. Hekimler Yayın Birliği. 1999.
• Coşkunol H, Bağdiken İ, Sorias S, Saygılı R. SCID-II görüşmesinin kişilik bozukluklarındaki güvenilirliği. Türk Psikoloji Dergisi. 1994;9 (32):26-9.
• Gibbon M, Spitzer RL, Williams JB. Structured clinical interviev for DSM-IV axis II personality disorders. Am Psych Pub. 1997.
• Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol.1995;52:768-74.
• Tamam L, Güleç H, Karataş G. Barratt Dürtüsellik Ölçeği Kısa Formu Türkçe Uyarlama Çalışması. Nöropsikiyatri arşivi. 2012;18(4),251-8.
• Bayam G, Dilbaz N, Bitlis V, Holat H, Tüzer T. İntihar davranışı ve depresyon, ümitsizlik, intihar düşüncesi ilişkisi: İntihar Davranış Ölçeği geçerlilik, güvenirlik çalışması. Kriz Dergisi. 1995;3(1-2):223-5.
• Linehan M, Nielsen S. Assessment of suicide ideatıon and parasuicide. Hopelessness and social desirability. J Con & Clın Psychology. 1981;49(5):773-5.
• Bernstein DP, Fink L, Handelsman L, Foote J. Initial reability and validity of a new retrospective measure of child abuse and neglect. Am J Psychiatry. 1994;151(8):1132-6.
• Sar V, Öztürk V, İkikardeş E. Validity and reliability of the Turkish version of the childhood trauma quastionnaire. Journal of Medical Scienses. 2012;32(4):1053-63.
• Dilsaver SC, Yhan Who C, Swann AC. Suicidality in patients with pure and depressive mania. Am J Psychiatry. 1994;151:1312-5.
• Goldberg JF, Garno JR, Portera L. Correlates of suicidal ideation in dysphoric mania. J Affect Disord. 1999;57:75-81.
• Keller MB, Lavori PW, Correll W. Differential outcome of pure manic , mixed/cycling, and pure depressive epizodes in patients with bipolar illness. Jama. 1986;144:96-8.
• Prien RF, Himmelhoch JM, Kupfer DJ. Treatment of mixed mania. J of Affect Disord. 1988;15:9-15.
• McElroy SL, Keck PR Jr, Pope HG Jr. Clinical and researh implications of the diagnosis of dysphoric or mixed mania or hypomania. Am J Psychiatry. 1992;149:1633-44.
• Goodwin FK, Jamison KR. Manic Depressive Illness. New York, NY Oxford University Press. 1990.
• Clothier J, Swann AC, Freeman T. Disphoric mania. J Clin Phsycopharmacol. 1992;12:13-6.
• Himmelhoch JM, Mulla D, Neil JF. İncidence and significance of mixed affective states in a bipolar population. Arch Gen Psychiatry. 1976;33:1062-6.
• Sonne SC, Brady KT. Substance abuse and bipolar comorbidity. Psychiatr Clin North Am. 1999;22:17-22.
• Bulik CM, Carpenter LL, Kupfer DJ, et al. Features associated with suicide attempts in recurrent major depression. J Affect disord. 1990;18:29-27.
• Amsterdam JD, Garcia Espana F, Fawcett J. Efficacy and safety of fluoxetine in treating bipolar II depresif epizod. J Clin Psychopharmacol. 1998;18:435-40.
• Tondo L, Baldessarini RJ, Hennen J. Suicide attempts in major affective disorder patients with comorbid substance use disorder. J Clin Psychiatry. 1990;60:63-9.
• Lester D. Suicidal behavior in bipolar and unipolar affective disorders:a meta analysis. J Affect Disord. 1993;27:117-21.
• Vieta E, Benabarre A, Colom F. Suicidal behavior in bipolar I and bipolar II disorder. J Nerv Ment Dis. 1997;185:407-9.
• Valtonen H. Suicidal behaviour in bipolar disorder. Helsinki: National Public Health İnstitute. 2007.
• Carballo JJ, Harkavy-Friedman J, Burke AK. Family history of suicidal behavior and early traumatic experiences: addictive effect on suicidality and course of bipolar ilness. Journal of Affective Disorders. 2008;109(1-2):57–63.
• Pezawas L, Stamenkovic M, Jagsch R, Ackerl S, Putz C. A longitudinal view of triggers and thresholds of suicidal behavior in depression. J Clin Psychiatry. 2002;63:866–73.
• Lejoyeux M, Arbaretaz M. Impulse control disorders and depression. J Nerv Ment Dis. 2002;190:310–4.
• Maser JD, Akiskal HS, Schettler P, Scheftner W, Mueller T, Endicott J, et al. Can temperament identify affectively ill patients who engage in lethal or near-lethal suicidal behavior? A 14-year prospective study. Suicide Life Threat Behav. 2002;32:10–32.
• Swann AC, Anderson JC, Dougherty DM, Moeller FG. Measurement of inter-episode impulsivity in bipolar disorder. PsychiatryRes. 2001;101:195–7.
• Swann AC, Pazzaglia P, Nicholls A, Dougherty DM, Moeller FG. Impulsivity and phase of illness in bipolar disorder. J Affect Disord. 2003;73:105–11.
• Allen TJ, Moeller FG, Rhoades HM, Cherek DR. Impulsivity and history of drug dependence. Drug Alcohol Depend. 1998;50:137–45.
• Barratt ES, Patton JH. Impulsivity: cognitive, behavioral, and psychophysiological correlates, in Biological Basis of Sensation- Seeking, Impulsivity, and Anxiety. Edited by Zuckerman M. Hillsdale, NJ, Lawrence Erlbaum Associates, 1983, pp 77–122.
• Soloff PH, Lynch KG, Kelly TM, Malone KM, Mann JJ. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. Am J Psychiatry. 2000;157:601–8.