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Am J Psychiatry 1994; 151:1312-1315
Copyright © 1994 by American Psychiatric Association
Suicidality in patients with pure and depressive mania
SC Dilsaver, YW Chen, AC Swann, AM Shoaib and KJ Krajewski
Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston.
OBJECTIVE: A previous comprehensive literature review indicated that
suicide accounted for 18.9% of the deaths of 9,389 individuals with
manic-depressive illness. The literature associates these deaths with the
depressed phase of the disease. This study was designed to determine the
rate and severity of suicidality among patients with pure and depressive
mania. METHOD: The patients were 93 persons who met the Research Diagnostic
Criteria (RDC) for bipolar I disorder (N = 75) or schizoaffective disorder
(N = 18). All met the RDC for primary mania and the DSM-III-R criteria for
bipolar disorder, manic or mixed. Patients with depressive mania met the
RDC for mania and major depressive disorder concurrently. Severity of
current suicidality was measured by using the Schedule for Affective
Disorders and Schizophrenia suicide subscale. Differences in the mean
suicidality scores between any two groups were assessed with the
Kruskal-Wallis test. Relationships of age, gender, type of affective
illness (bipolar I versus schizoaffective disorder), psychosis, race, and
mania subtype to suicidality were assessed by using multivariate logistic
regression analysis. RESULTS: One (2.0%) of the 49 patients with pure mania
was suicidal. In contrast, 24 (54.5%) of the 44 patients with depressive
mania were suicidal. This difference was highly significant. Gender and
psychosis were not related to suicidality. African-Americans were less
likely to be suicidal than Caucasians. Subtype of mania had the strongest
relationship to suicidality. CONCLUSIONS: A subgroup of manic patients are
severely suicidal. Presentation in the manic state is an indication for
careful assessment of depressive symptoms and suicidality.
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