Suicide in a large population of former psychiatric inpatients

Abstract

Aims:The aim of this study was to identify predictors of completed suicide in a wide sample of psychiatric inpatients receiving retrospective and prospective DSM-IV diagnoses. Methods:We followed up 4441 severe psychiatric patients who were hospitalized for some time during a 35-year period in a private hospital setting. We collected sociodemographic, clinical and temperamental data.Results: Ninety-six patients from the sample committed suicide. There were no sex differences in suicide completion and no differences between major psychiatric disorders, but people who had been hospitalized for anxiety disorders did not commit suicide and people with bipolar disorders were more likely to commit suicide than people with unipolar major depression. Shorter-term treatment with lithium and anticonvulsants, longer-term treatment with antidepressants, history of suicide attempts, suicidal thinking, and single status positively predicted completed suicide. Suicide tended to occur after a mean period of about 14 years of duration of disease. Patients' symptoms during the period preceding suicide were assessed through interviewing patients' physicians or family members. Symptoms occurring in >10% of cases were, in decreasing order, inner tension, racing/crowded thoughts, aggressive behavior, guilt, psychomotor agitation, persecutory ideation, anxiety, and hallucinations. Surprisingly, cyclothymic temperament was less associated with completed suicide as compared to other temperaments. Conclusions:Suicide is likely to occur in a milieu of agitation, mixed anxiety and depression, and psychosis. Longer-term mood stabilizer treatment may reduce the rate of completed suicide.

Childhood traumatic experiences of patients with bipolar disorder type I and type II

“…In fact, according to the logistic regression analysis emotional abuse is strongly linked to lifetime suicide attempts, independently of whether BD I or BD II is diagnosed. This finding suggests the importance of adopting a dimensional approach towards suicidality in BD (Sani et al,2011). Particularly, emotional abuse is a significant predictor of presence of life time suicide attempts in BD.…”

Subjective Experience of Thought Overactivation in Mood Disorders: Beyond Racing and Crowded Thoughts

“…A first concern is suicidal risk. Interviews with physicians and family members of patients who committed suicide revealed that inner tension (54%) and racing/crowded thoughts (53%) were the most prevalent symptoms during the period preceding suicide [37]. Other studies on bipolar II disorder [38] and major depressive disorder [7] have shown that suicidal ideation was associated with racing/crowded thoughts.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…This is because patients with BDII spend as much time symptomatic as those with BDI, with mood symptoms predominantly in the depressive phase 427, 428. Rates of attempted and completed suicide are similar in BDI and BDII, with approximately one‐third of patients with BDII attempting suicide over the course of their illnesses429 and one in twenty‐five completing suicide 430…”