What special precautions would you take to lower the risk of suicide in patients diagnosed with mania with depressive symptoms?

I would make sure I meet their family members, as well as undertaking psychoeducation.

Could you describe the ways in which patients suffering bipolar mania with depressive symptoms are particularly burdened by their condition? (e.g. symptoms or comorbidities)

They don’t work and they often have family difficulties - contact with family often decreases when patients experience depressive symptoms. Sometimes they have financial and social problems.

What incidence of comorbidities (weight gain, cardiovascular problems, etc.) do you see in your bipolar I patients?

Addiction is the main problem. I see lots of problems associated with alcohol addictions, or cannabis.

What type of comorbid conditions do you feel need the most urgent attention? Why?

• Physical (e.g. obesity, CVD)
• Medical (e.g. hypothyroidism, multiple sclerosis)
• Psychiatric (e.g. ADHD, personality disorders, substance abuse)

I think we should deal with the physical first. Patients often gain a lot of weight with medication. Not because of bipolar disorder itself, but due to the medication. With the psychiatric, we should deal with substance abuse - I see a lot of cannabis abuse.