Is there an association between suicide attempt and delay of initiation of mood stabilizers in bipolar I disorder?

• Published in: Journal of affective disorders 2012-02, Vol.136 (3), p.1082-1087
• Main Authors: Nery-Fernandes, Fabiana, Quarantini, Lucas C, Guimarães, José L, de Oliveira, Irismar R, Koenen, Karestan C, Kapczinski, Flavio, Miranda-Scippa, Ângela
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar disorders; Female; Humans; Male; Medical sciences; Middle Aged; Mood disorders; Mood stabilizer; Neuropharmacology; Pharmacology. Drug treatments; Psychiatry; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Psychotropic Drugs - therapeutic use; Retrospective Studies; Suicidal behavior; Suicide; Suicide attempt; Suicide, Attempted; Time Factors; Treatment
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2011.10.046

Abstract Background Little is known about the extent to which delay of initiation of mood-stabilizing treatment may influence outcomes in bipolar patients (BP). In this study, our aim was to investigate the association between delay of mood stabilizer treatment in bipolar patients and lifetime history of suicide attempts. Method A consecutive sample of 268 bipolar I outpatients from two teaching hospitals in Brazil was recruited. The assessment included a socio-demographic history form, a clinical interview regarding clinical variables and the Structured Clinical Interview for DSM-IV. Participants were divided into three groups: BP that initiated the first mood stabilizer in the same year of the first episode of the disease (FMS ≤ 1), between 1 and 5 years after the first episode of the disease (1 < FMS ≤ 5), and after 5 years after the first episode of BD (FMS > 5). Results The mean time from the first episode until the first mood stabilizer medication was 8.6 years (SD 9.8 years). The FMS > 5 group, showed a higher lifetime prevalence of suicide attempts than the other two groups (PR = 1.75, 95% CI: 1.24–2.47), p = 0.001. These results remained significant after adjusting for potential confounders, (PR = 1.82, 95% CI: 1.29–2.60), p = 0.001. Limitations This study evaluated patients retrospectively and does not permit a cause-effect relationship. Conclusion The present study supports the importance of early diagnosis and early intervention for BP in order to limit the potentially lethal impact of the disease.