Suicidal events and accidents in 216 first-episode bipolar I disorder patients: Predictive factors
Suicidal events and accidents in 216 first-episode bipolar I disorder patients: Predictive factors
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DOI：
10.1016/j.jad.2007.05.027
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发表时间：
2008-02-01
影响因子：
6.6
通讯作者：
Baldessarini, Ross J.
中科院分区：
文献类型：
--
作者：
Khalsa, Hari Mandir Kaur;Salvatore, Paola;Baldessarini, Ross J.
背景：在双相情感障碍(BPD)患者中，威胁生命的行为的风险很高，但自杀和事故的早期发生率和相关危险因素仍不明确。方法：我们前瞻性地评估了216名DSM-IV BP-I患者从首次住院起4.2年的风险，使用有序Logistic回归估计危险组中的风险和相关的人口统计学和临床因素：[1]没有自杀意念、行为或事故，[2]仅有自杀意念，[3]自杀和企图，[4]事故，结果：有自杀念头或自杀行为的有127/216人/4.2年(14%/年)，其中有自杀意念的88人(9.7%/年)，自杀行为39人(4.3%/年：38次自杀未遂[7.6%/年]，自杀[0。11%/年])；87%的行为发生在第一集的一年内。发生危及生命的事故20例(2.2%/年)，平均潜伏期3.8年，其中12例有自杀意念或企图(60%的事故和自杀同时发生)；25%的事故与酒精有关。暴力行为53例(5.84%/年)，包括一起致命车祸和一起自杀，死亡风险为0.22%/年(2/216/4.2岁)。自杀倾向与最初的混合状态、混合状态或抑郁症的随访周比例以及既往的自杀企图有关；事故与最初的躁狂或精神病、后来的躁狂或轻躁以及酗酒有选择性地相关。暴力行为也与每人使用更多的精神药物，以及使用抗精神病药物或镇静-抗焦虑药物有关。限制：治疗是临床和非控制的，疾病相对严重，统计能力有限。结论：BP-I障碍早期自杀行为和事故的风险很高，相互关联，并与特定类型的初始和晚期发病率相关，这表明预防干预具有一定的可预测性和潜力。(C)2007 Elsevier B.V.保留所有权利。
Background: Risks of life-threatening behaviors are high among bipolar disorder (BPD) patients, but early rates and associated risk factors for suicides and accidents remain ill-defined.Methods: We assessed 216 DSM-IV BP-I patients prospectively for 4.2 years from first-lifetime hospitalization, using ordinal logistic-regression to estimate risks and associated demographic and clinical factors among risk-groups with: [1] no suicidal ideation, acts, or accidents, [2] suicidal ideation only, [3] suicides and attempts, [4] accidents, and [5] both suicidal acts and accidents.Results: Suicidal thoughts or acts were identified in 127/216 subjects/4.2 years (14%/year), including suicidal ideation in 88 (9.7%/year), and acts in 39 (4.3%/year: 38 attempts [I 7.6%/year], I suicide [0. 11 %/year]); 87% of acts occurred within a year of a first-episode. Life-threatening accidents occurred in 20 cases (2.2%/year) with a mean latency of 3.8 years, including 12 with suicidal ideation or attempts (60% co-occurrence of accidents and suicidality); alcohol was implicated in 25% of accidents. The 53 cases of violent behaviors (5.84%/year) included a fatal car-wreck and a suicide, for a mortality risk of 0.22%/year (2/216/4.2 years). Suicidality was associated with initial mixed-state, proportion of follow-up weeks in mixed-states or depression, and prior suicide attempts; accidents were associated selectively with initial mania or psychosis, later mania or hypomania, and alcohol abuse. Violent acts also were associated with use of more psychotropic medicines/person, and with use of antipsychotics or sedative-anxiolytics.Limitations: Treatment was clinical and uncontrolled, illness relatively severe, and statistical power limited.Conclusions: Early in BP-I disorder, risks of suicidal acts and accidents were high, inter-related, and associated with particular types of initial and later morbidity, suggesting some predictability and potential for preventive intervention. (c) 2007 Elsevier B.V. All rights reserved.