What are the best ways to manage suicide risk among people with bipolar

Objective:

1. To identify the rate or percentage of the people who are experiencing symptoms of bipolar disorder.
2. To know if there’s a new scientific method or new solution that does by medical technologist or doctor to
solve this kind of disorder.
3. To help some students or people who experiencing this kind of disorder
4. To find out the different ways to overcome or to manage suicidal risk when it comes to bipolar order

Significance of the study

This study is to establish an understanding to the different ways to manage suicidal risk among people with
bipolar. Through research this study will help our fellow students to know the best ways to manage suicidal risk
among people with bipolar their will help their family or friends who have this kind of disorder. Also this
research will maybe help the future researcher, because he or she will know the difference of our research to
the past research when it comes to the medication of bipolar disorder.

Respondents:

1. College students (psychologists)

2. Doctor & nurses

Related Studies

Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy

predict suicidal intent?

Abstract

The aims of the present study were to examine clinical, personality, and socio demographic predictors of
suicide risk in a sample of inpatients affected by major affective disorders. The participants were 74
inpatients affected by major depressive disorder or bipolar disorder-I. Patients completed a semi-structured
interview, the Beck Hopelessness Scale, the Aggression Questionnaire, the Barratt Impulsiveness Scale, and
the Hamilton scales for depression and anxiety. Over 52% of the patients were high suicide risks. Those at
risk reported more severe depressive-anxious symptom mat logy, more impulsivity and more hostility.
Impulsivity, the use of antidepressants, anxiety, and the use of mood stabilizers (a negative predictor)
resulted in accurate predicting of suicide intent. Impulsivity and antidepressant use were the strongest
predictors even after controlling for several socio demographic and clinical variables.

Results

Patients reported high scores on hopelessness, and over 52% evidenced scores higher than 9, indicating high
suicide intent .No differences were found by sex or diagnosis. Twenty-seven people (36.5%) reported a
 history of suicide attempts, and 16 (21.6%) reported multiple suicide attempts. Female patients were more
likely to have attempted suicide than male patients, while men reported more physical aggressiveness. No
differences were revealed between MDD and BPD patients. Thus, we may consider in patients with MAD to
be a group at high risk of suicide behavior, with the female patients at higher risk.Patients with major
depressive disorder reported more depression, somatization and symptoms of anxiety, retardation and
diurnal variation. The analysis indicated differences in the drug therapy between patients at risk of suicide
and patients without risk. Patients reporting more hopelessness are more likely to have been prescribed
antidepressants (SSRI) and less likely to have been prescribed mood stabilizers (lithium, carbamazepine,
lamotrigine) and antipsychotics (olanzapine, quetiapine), the effect sizes of this difference being
low/moderate. This might be due to the strong relationship between depression and hopelessness; however,
suicide risk may be understood as constriction, tunneling, or focusing or narrowing the range of options
usually available to an individual’s consciousness, when the individual cannot see any way out and therefore
loses any positive expectation about the future, which leads to a hopeless feeling regardless of diagnosis. The
fact that those experiencing hopelessness were prescribed more antidepressants should be viewed with
caution. In fact, evidence emerging from clinical practice is suggestive that mood stabilizers can decrease the
feelings of anguish and despair that are often associated with hopelessness both in unipolar and bipolar
patients. Moreover, such drugs reduce the agitation components of depressive-dysphonic states which often
are correlated with impulsiveness and aggression and often found in suicidal crisis.

Recommendations:
The generalizability of our findings is limited by the usual difficulties of a retrospective assessment of suicide
attempts and the review of clinical chart records. Furthermore, suicide attempts could not be classified
retrospectively for their potential lethality. Finally, our patients had in some cases complex treatment
regimens, including antidepressants administered alone, in combination or as add-on therapy. It could be
argued that suicidality in these patients was affected by the antidepressant treatment. However clear
scientific evidence supporting this notion is still lacking. One major point for further investigation is to take
into consideration past pharmacological treatment including time and dosage. In conclusion, we stress the
need to better screen MAD patients for aggressiveness and impulsivity as well as suicide intent. The use of
proper pharmacological therapy (especially lithium) can dramatically decrease deaths from suicide.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515901/

Suicidal risk in bipolar I disorder patients and adherence to long-term lithium treatment.

Abstract

Among the well-established treatments for bipolar disorder (BPD), lithium continues to offer an unusually
broad spectrum of benefits that may include reduction of suicidal risk. We examined the association of
suicidal acts with adherence to long-term lithium maintenance treatment and other potential risk factors in
72 BP I patients followed prospectively for up to 10 years at a Mood Disorders Research Center in Spain.
Results:

The observed rates of suicide were 0.143, and of attempts, 2.01%/year, with a 5.2-fold (95% CI: 1.5-18.6)
greater risk among patients consistently rated poorly versus highly adherent to lithium prophylaxis (11.4/2.2
acts/100 person-years). Treatment non-adherence was associated with substance abuse, being unmarried,
being male, and having more hypo manic-manic illness and hospitalizations. Suicidal risk was higher with
prior attempts, more depression and hospitalization, familial mood disorders, and being single and younger,
as well as treatment non-adherence, but with neither sex nor substance abuse. In multivariate analysis,
suicidal risk was associated with previous suicidality poor treatment adherence > more depressive episodes
younger age.

Recommendations:

The clinician should encourage self-control, self-esteem and the ability to face one's own individual problems
and should promote greater participation and integration in family and social environments. The most
effective strategies to prevent suicide include prescribing antidepressant medication to patients who suffer
from depression and controlling access to means of committing suicide. Clozapine and lithium have been
shown to have a protective effect against suicide in schizophrenic and bipolar patients, respectively. In any
case, for patients with mental disorders and suicide risk, continuity of care and support should be ensured, in
addition to appropriate treatment that includes verifying their adherence to the full dose of the medication.
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1399-5618.2006.00368.x

Suicide Risk in Co morbid Bipolar Disorder and Obsessive-Compulsive Disorder: A Systematic Review

Abstract

The co-occurrence of bipolar disorder (BD) and obsessive-compulsive disorder (OCD) seemed to be a poor
prognostic factor associated with greater disability, lower social and occupational functioning, poorer
treatment response, and higher suicidal ideas and attempts compared to BD patients. A systematic review
was conducted on the risk of suicide in BD-OCD patients compared to BD patients. Relevant papers published
through August 2018 were identified searching the electronic databases MEDLINE, EMBASE, PsycINFO, and
the Cochrane Library. The co-occurrence of bipolar disorder (BD) and obsessive-compulsive disorder (OCD)
was noted 150 years ago by the French psychiatrist Morel, but the significance of this co morbidity has not
been sufficiently clarified yet.
Results
In all cases, diagnoses were according to the standard Diagnostic and Statistical Manual criteria and were
established using validated assessment scales. More than 80% of the selected studies presented higher rates
of history of suicide attempts and lifetime depressive episodes in BD-OCD patients compared to non-co
morbid patients. Ten studies were selected. In all cases, diagnoses were according to the standard Diagnostic
and Statistical Manual (DSM) criteria and were established using validated assessment scales. More than 80%
of the selected studies presented higher rates of history of suicide attempts and lifetime depressive episodes
in BD-OCD patients compared to non-co morbid patients.] In the Epidemiologic Catchment Area (ECA)
database, BD-OCD patients had statistically significant higher lifetime rates of “thoughts of suicide,”
“thoughts of death,” “suicide attempts,” and “wanting to die” versus non-co morbid patients. These features
 were also confirmed in a case-control study conducted in the USA in the adolescent population. OCD was
associated with a 2.4-fold increase in the odds of suicidal ideation among BD adolescents as compared to
non-co morbid adolescents. Less than 20% of the selected studies did not report a statistically significant
difference in terms of suicide attempts between co morbid and non-co morbid patients.
Recommendations:
Osler's view that medicine should be a treatment of diseases, not of symptoms, is consistent with the
approach of mood stabilization as the first objective in apparent BD-OCD patients, as opposed to immediate
treatment with antidepressants. In line with that, especially in co morbid patients, lithium may be preferred
because of its proven anti-suicidal effect. Suicide prevention should involve accurate detection, diagnosis
and treatment of depressive disorders, schizophrenia, anxiety disorders, consumption of toxic substances
and personality disorders, among other disorders. It is necessary to assess suicidal behavior more thoroughly
and systematically in the clinic, as well as to record the suicide risk assessment.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436414/

Related Articles:
Article 1
Bipolar Disorder and Suicide Risk

It can be scary to watch someone display any of the warning signs of suicide, but recognizing these red flags
before there may be a problem, especially in cases of adults or teens with bipolar disorder is best .It is
estimated that nearly thirty percent of those diagnosed with bipolar disorder will attempt suicide at least
once in their lives. The suicide rate for people with bipolar disorder is twenty times that of the general
population. These numbers are even more frightening when we consider the "average" suicide risk in the
general population. The Centers for Disease Control and Prevention (CDC) reported that suicide was the
eighth-ranked cause of death in the United States. It was the third leading cause of death for those ages 10-
24 and the second leading cause for ages 25-34. Multiply these numbers by the increase seen with bipolar
disorder and it's even clearer why understanding the indicators below is so important. The subject of suicide
is not something we can ignore. We should all be aware of the risk factors for suicide, whether or not a
person has bipolar disorder. Every single one of us needs to know the warnings signs, the red flags of despair,
so we may be prepared to help a friend or loved one in crisis, and be prepared to hear their cry for help. In
younger people, we need to be familiar with the warning signs of suicide in teens, as some of these may be
dismissed as ordinary teen. We also need to know where and how to seek help if we experience suicidal
thoughts ourselves. Even the most emotionally healthy individuals on the planet sometimes experience the
despair that can lead to suicide.https://www.verywellmind.com/red-flags-warning-signs-of-suicide-379034

Article 2

Bipolar Disorder Signs and Symptoms

We all have our ups and downs, but with bipolar disorder (once known as manic depression or manic-
depressive disorder) these peaks and valleys are more severe. Bipolar disorder causes serious shifts in mood,
energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the
other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or
 months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they can
interfere with your job or school performance, damage your relationships, and disrupt your ability to
function in daily life During a manic episode, you might impulsively quit your job, charge up huge amounts on
credit cards, or feel rested after sleeping two hours. During a depressive episode, you might be too tired to
get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt. The causes of
bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or
depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood. The symptoms
can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed—resulting
in unnecessary suffering. Since bipolar disorder tends to worsen without treatment, it’s important to learn
what the symptoms look like. Recognizing the problem is the first step to feeling better and getting your life
back on track. https://www.helpguide.org/articles/bipolar-disorder/bipolar-disorder-signs-and-symptoms.htm

Article 3

Helping Someone with Bipolar Disorder

Dealing with the ups and downs of bipolar disorder can be difficult—and not just for the person with the
illness. The moods and behaviors of a person with bipolar disorder affect everyone around—especially family
members and close friends. It can put a strain on your relationship and disrupt all aspects of family life during
a manic episode, you may have to cope with reckless antics, outrageous demands, explosive outbursts, and
irresponsible decisions. And once the whirlwind of mania has passed, it often falls on you to deal with the
consequences. During episodes of depression, you may have to pick up the slack for a loved one who doesn’t
have the energy to meet responsibilities at home or work. The good news is that most people with bipolar
disorder can stabilize their moods with proper treatment, medication, and support. Your patience, love, and
understanding can play a significant in your loved one’s treatment and recovery. Often, just having someone
to talk to can make all the difference to their outlook and motivation. But caring for a person with bipolar
disorder can also take a toll if you neglect your own needs, so it’s important to find a balance between
supporting your loved one and taking care of yourself.

Other ways to help someone with bipolar disorder.. Learn everything you can about the symptoms and
treatment options. The more you know about bipolar disorder, the better equipped you’ll be to help your
loved one and keep things in perspective.. The sooner bipolar disorder is treated, the better the prognosis, so
urge your loved one to seek professional help right away. Don’t wait to see if they will get better without
treatment.. Let your friend or family member know that you’re there if they need a sympathetic ear,
encouragement, or assistance with treatment. People with bipolar disorder are often reluctant to seek help
because they don’t want to feel like a burden to others, so remind the person that you care and that you’ll do
whatever you can to help. Don’t expect a quick recovery or a permanent cure. Be patient with the pace of
recovery and prepare for setbacks and challenges. Managing bipolar disorder is a lifelong process.
https://www.helpguide.org/articles/bipolar-disorder/helping-someone-with-bipolar-
disorder.htm?fbclid=IwAR0gnUFBgsSgNx0TWrMMnC52Tz0mIopLhv29XAXLennGUoLQTHunBgj5G80