Correlates of suicidal ideation in dysphoric mania

Background: Previous investigations have reported that suicidal ideation an d behavior are more prevalent during mixed than pure mania. Uncertainties e xist about whether suicidality in mania arises from multiple concurrent dep ressive symptoms, or rather, as a categorical phenomenon, reflecting dyspho ria without necessarily a full major depression. To elucidate the relations hip between suicidal ideation and dysphoric mania, we analyzed clinical and demographic features associated with suicidal versus nonsuicidal dysphoric manic inpatients. Methods: Records were reviewed for 100 DSM-III-R bipolar I manic inpatients at the Payne Whitney Clinic of New York Hospital from 1 991-1995. ALI had greater than or equal to 2 concomitant depressive symptom s (other than suicidality). Affective and psychotic symptoms, past suicide attempts, prior illness, and related clinical/demographic variables were as sessed by a standardized protocol. Results: Suicidal ideation was significa ntly more common among dysphoric manics who were caucasian, took antidepres sant medications in the week prior to admission, had histories of alcohol a buse/dependence, and made past suicide attempts. Suicidal ideation was evid ent for nearly half of dysphoric manic patients with less than or equal to 3 depressive symptoms who did not meet DSM criteria for a mixed state. No i ndividual manic or depressive symptoms other than dysphoric mood were more common among suicidal than nonsuicidal patients. Limitations: Findings from this retrospective study require confirmation using a prospective assessme nt. Treatments were naturalistic and may have differentially influenced hos pital course and illness characteristics. Factors related to suicide attemp ts (rare in this cohort) or completions (not a focus of this study) may dif fer from those related only to suicidal ideation. Conclusions: Caucasian dy sphoric manic patients with past suicide attempts and substance abuse may h ave a significantly elevated risk for suicidality, even when full major dep ression does not accompany mania, Suicidality is a clinically important con sideration in a majority of dysphoric manic patients. (C) 1999 Elsevier Sci ence BN. All rights reserved.