In a new series "Top of the Polls", we take a look at the polls we’ve conducted at international conferences, together with commentaries by our key opinion leaders to contextualise the results and highlight useful learning points. In the first part we look at questions asked at International Society of Bipolar Disorders (ISBD) 2015 which focusses on suicide and its tell-tale signs in bipolar I.
Over the past couple of years at key international psychology conferences we’ve asked delegates to answer questions about bipolar I. The idea was to find out what you knew about different aspects of this serious condition and to gain insight about the way clinicians are currently managing bipolar I. We then asked our key opinion leaders to comment on our findings, with a view to contextualising the results and highlighting some useful learning points.
The response has been terrific and provided fascinating insight into how things really are in clinical practice and in some instances the knowledge gaps that could lead to less than optimal management of bipolar I.
In the first part we look at questions asked at the 17th Annual Conference of the International Society of Bipolar Disorders (ISBD), Toronto, Canada which focusses on suicide and its tell-tale signs in bipolar I.
Risk of suicide highest in bipolar I
It’s a topic high on the agenda at international meetings and so increasing numbers of people are beginning to recognise that risk of suicide among patients with bipolar disorder is high – up to 20-30 times greater than in the general population.1 In fact bipolar disorder may account for one-quarter of all completed suicides.
Suicide attempts are also more prevalent in bipolar I than in bipolar II; this makes sense given that the presence of mixed states (mania with depressive symptoms) in bipolar I is associated with a higher suicide risk.
First question
We asked our audience whether THEY were aware that suicide and suicidal ideation is more common during mixed states in bipolar I disorder compared to manic or depressed episodes. Encouragingly 84% of respondents said yes to the question. “Our patients will undoubtedly benefit from this awareness,” said our guest commentator Dr Umberto Albert, Assistant Professor of Psychiatry, Rita Levi Montalcini Department of Neuroscience Mood and Anxiety Disorders Unit, University of Torino, Italy.
Dr Umberto talks about possible explanations for the higher incidence of suicide attempts among people with mixed states in his commentary that you can read here.
Mania with depressive symptoms = suicidal ideation?
It was then of interest to reveal that 91% of respondents recognized that most of their manic patients with depressive symptoms suffer from suicidal ideation. “This implies that they correctly investigate both the presence/absence of depressive symptoms and the presence/absence of suicidal ideation. Their patients also should be glad to know that their treating psychiatrists focus their attention on these aspects during the diagnostic assessment,” said Dr Albert.
Agitation, irritability and anxiety (AIA): key warning signs to suicidal ideation
Results of the next question offered hope in terms of knowing the warning signs as to when someone with bipolar I is more likely to attempt suicide. The combination of anxiety, irritability and agitation (AIA) are a clue that depressive symptoms may also be present during an episode of mania. In one large self-report study, 72% of patients who experienced mania with depressive symptoms suffered from AIA.3
When asked: ‘Do most of your manic patients with depressive symptoms experience anxiety, irritability and agitation?’ the majority of respondents to the poll (approximately 90%) agreed that most of their manic patients with depressive symptoms experience anxiety, irritability and agitation. “The proportion of those who disagree may see, in their clinical practice, less severe patients, with more prototypical (DSM-5) bipolar disorder subjects,” said Dr Umberto.
Dr Umberto added: “The vast majority of participants to the poll (88%) acknowledged that the combination of anxiety, irritability and agitation helps them in their clinical practice to identify patients with bipolar I disorder who have suicidal ideation. This could show that literature results are well known by these clinicians and that the relevance of this cluster of symptoms is recognized by respondents based on their clinical practice.”
Coming soon….
In the second part of this series, we will look at results from our poll from the International Review of Psychosis & Bipolarity (IRPB) 2015, which took place in Lisbon, Portugal this April. Revelations include how participants have viewed progress in the management of bipolar I over the past decade and how the switch to DSM-5 has benefited these patients.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
