Rapid mood switching and suicidality in familial bipolar disorder

Authors

  • Dean F MacKinnon,

    1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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  • James B Potash,

    1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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  • Francis J McMahon,

    1. Genetic Basis of Mood & Anxiety Disorders, National Institute of Mental Health, National Institutes of Health, Department of Health & Human Services, Bethesda, MD
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  • Sylvia G Simpson,

    1. Department of Psychiatry, University of Colorado Health Sciences Center, Denver, CO
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  • J Raymond DePaulo Jr,

    1. Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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  • the National Institutes of Mental Health Bipolar Disorder Genetics Initiative,

    1. Indiana University (John Nurnberger); Johns Hopkins University (J. Raymond DePaulo, Jr., Melvin McInnis – currently at University of Michigan); National Institute of Mental Health Intramural Research Program (Francis McMahon, Dennis L Murphy); Rush University (William Scheftner); University of Iowa (William Coryell); University of Pennsylvania (Wade Berrettini); University of California, Irvine (William Byerley – currently at University of California, San Francisco); University of California, San Diego (John Kelsoe); University of Chicago (Elliot Gershon); Washington University at St Louis (Theodore Reich, deceased 12/03, John Rice)
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  • Peter P Zandi

    1. Bloomberg School of Public Health, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Corresponding author: Dean F MacKinnon, MD, Meyer 3-181, 600 N Wolfe St, Baltimore, MD 21287, USA. Fax: 443 287 6330; e-mail: dmackin@jhmi.edu

Abstract

Objectives:  Rapidly alternating or mixed mood states in bipolar disorder are associated with a particularly high risk for suicidal behavior. Are individuals with these patterns of illness more likely to develop suicidal intentions, or are they less able to resist them? This analysis examines the specific contribution of rapid switching and other variables to the relative likelihood of having or acting on self-reported suicidal thought and action, in a large group of individuals with bipolar disorder.

Methods:  The analysis included 1574 family members with bipolar disorder interviewed for a multi-site bipolar disorder genetic linkage study. Two models were tested, using the same set of demographic and clinical data points as independent variables. One model tested the influence of rapid switching and other variables on self-reported suicidal thought or action (i.e., suicidality), while the other tested the influences on suicidal action only among those who reported a history of suicidality.

Results:  Over 75% of subjects had contemplated suicide and 38% reported a history of suicidal behavior. A history of rapid switching was associated with higher likelihood of a history of suicidality, as was panic disorder. Familial suicidal behavior, as well as drug abuse, increased the likelihood of suicidal action among suicidal individuals, but did not increase the likelihood of becoming suicidal. Female sex, early age at onset, and several demographic factors were associated with both facets of suicidality.

Conclusions:  Factors associated with high acuity of distress, such as panic attacks and unstable moods, appear to enhance the risk of suicidality in general. Factors that affected the threshold for action without increasing suicidality overall can also be seen as markers of impulsive decision-making. Of the two distinct kinds of suicidal risk, the latter – the likelihood of action given intent – appears to be the more familial.

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