Citation

Hawton KE. Psychiatr. Danub. 2006; 18(Suppl 1): 33-34.

Affiliation

Centre for Suicide Research, University Department of Psychiatry, OX3 7JX Oxford, UK. (keith.hawton@psychiatry.oxford.ac.uk)

Copyright

(Copyright © 2006, Facultas Universitatis Studiorum Zagrabiensis - Danube Symposion of Psychiatry)

DOI

unavailable

PMID

16963886

Abstract

Aims and Objectives: Bipolar affective disorder (BPD) is associated with a high risk of suicide and attempted suicide. Detection and effective management of risk of suicidal behaviour are essential elements in the overall treatment of the disorder. Evidence from mainly observational studies has suggested that lithium treatment has an anti-suicidal effect in BPD. We have assimilated findings on risk factors for suicidal behaviour and on the effectiveness of lithium as an anti-suicidal agent. Method: Systematic reviews, using electronic databases, searching of references, contact with experts and original authors, and meta-analyses of findings on (i) risk factors for suicide (13 studies) and attempted suicide (23 studies) in BPD, and (ii) effects of lithium versus prophylactic treatments or placebo in randomised controlled trials (RCTs) (32 trials) on suicide, deaths from all causes and attempted suicide. Results: On the basis of meta-analysis of factors reported in more than one study the main risk factors for suicide in BPD are a previous suicide attempt and hopelessness. The main risk factors for suicide attempts include a family history of suicide, early onset of BPD, extent of depressive symptoms, increasing severity of affective episodes, mixed affective states, rapid cycling, co-morbid Axis I disorders, and abuse of alcohol or drugs. The systematic review of RCTs comparing the effects of lithium with other prophylactic treatments or placebo showed convincing evidence of an anti-suicidal effect of lithium and no increase in other deaths due to possible side-effects of lithium. Conclusions: Prevention of suicidal behaviour in BPD may be assisted by special vigilance in patients with specific risk factors identified in our review and greater use of lithium in the prophylaxis of the disorder.

Language: en