Heterogeneity of the risk of suicidal behavior in bipolar-spectrum disorders

被引:22
作者
Cavazzoni, Patrizia
Grof, Paul
Duffy, Anne
Grof, Eva
Mueller-Oerlinghausen, Bruno
Berghoefer, Anne
Ahrens, Bernd
Zvolsky, Petr
Robertson, Carrie
Davis, Alison
Hajek, Tomas
Alda, Martin
机构
[1] McGill Univ, Dept Psychiat, Montreal, PQ H3A 1A1, Canada
[2] Eli Lilly & Co, Lilly Res Labs, Indianapolis, IN 46285 USA
[3] Mood Disorders Clin, Ottawa, ON, Canada
[4] German Med Assoc, Drug Commiss, Berlin, Germany
[5] Charite Univ Med Ctr, Inst Social Med Epidemiol & Hlth Econ, Berlin, Germany
[6] Med Univ Lubeck, Dept Psychiat & Psychotherapy, D-23538 Lubeck, Germany
[7] Charles Univ Prague, Dept Psychiat, Prague, Czech Republic
[8] Royal Ottawa Hosp, Ottawa, ON K1Z 7K4, Canada
[9] Dalhousie Univ, Dept Psychiat, Halifax, NS, Canada
关键词
bipolar disorder; family study; lithium response; mood disorders; suicide;
D O I
10.1111/j.1399-5618.2007.00516.x
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives: The risk of suicidal behavior is substantially elevated in major affective disorders (AD). In bipolar disorder (BD), as many as 15% of patients may commit suicide and family history of suicide is recognized as one of the most important risk factors. Lithium reduces the rates of suicidal behavior in BD, especially in patients who achieve full mood stabilization. Yet even patients who continue experiencing mood episodes do benefit from anti-suicidal properties of lithium. These observations raise questions about the nature of the relationship between the neurobiological mechanisms of BD and suicide, namely whether they are shared or independent. Methods: We studied the distribution of suicides and suicide attempts in 539 subjects from 78 families of probands with major AD, all responders to lithium prophylaxis. A Cox proportional hazard regression model was used to assess the contribution of several independent variables to the risks of AD, BD, and suicidal behavior. Results: The lifetime prevalence of BD was significantly greater among first-degree relatives of suicide than non-suicide probands (22% versus 11%) and the prevalence of BD in families was associated with an increased risk of developing mood disorder and subsequently committing or attempting suicide (p = 0.003). Families fell into 1 of 3 groups, corresponding to a low (< 0.1%), intermediate (17.8%), and high (87.8%) risk for suicide in affectively ill subjects. Conclusions: Suicidal behavior is distributed unevenly in families of probands with BD, aggregating in a subset of families. Our results also suggest that partially overlapping sets of genetic factors may underlie BD and suicide.
引用
收藏
页码:377 / 385
页数:9
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