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Panic attacks and suicidality in bipolar patients

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Abstract

Background

Bipolar disorders are among the most common life-threatening psychiatric illnesses due to suicide. Anxiety is the forgotten problem of bipolar disorder.

Aim

The aim of the study was to assess suicide and panic attacks in bipolar I patients and to assess the relationship between comorbid panic attacks and bipolar I disorder (manic, depressive, and mixed) and suicide.

Patients and methods

Approval from the ethical and research committees of the Department of Psychiatry, Kasr Al Aini Hospital was obtained. One hundred patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., as bipolar patients were divided into three groups: 55 bipolar manic patients with a mean age of 29.51±7.603, 26 bipolar depressive patients with a mean age of 31.58±8.051, and 19 bipolar mixed patients with a mean age of 32.31±9.151. They were recruited from Kasr Al Aini Psychiatric Hospital (inpatients and outpatients) during the active phase of the illness. Psychiatric examination was applied using the semistructured interview, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Axis I Disorders, Young Mania Rating Scale, Hamilton Depression Rating Scale, and Suicide Probability Scale.

Results

Most of the female patients showing subclinical suicide probability were bipolar manic patients (87.5%), whereas most of the bipolar mixed female patients and the bipolar depressive female patients showed moderate and severe suicide probability on Suicide Probability Scale (27.3 and 33.3%, respectively). Female patients in the bipolar mixed and depressive groups showed significantly higher mean scores on the hopelessness and suicidal ideation subscales compared with the manic group patients. Male patients showed significant difference on the four subscales of Suicide Probability Scale. Male patients of the bipolar mixed and depressive groups showed significantly higher mean scores on the hopelessness, suicidal ideation, and hostility subscales compared with patients of the manic groups. There was a significant difference between the three patient groups regarding the presence of panic attacks, regarding the presence of panic disorder, and regarding the presence of psychotic features. There was significant positive correlation between the suicide probability and past history of suicide, family history of psychosis of the manic group; past history of suicide, family history of suicide, family history of mood disorder, the presence of panic attacks/panic disorders during the mixed episode; and past history of suicide, family history of suicide, panic attacks/panic disorders during the depressive episode.

Conclusion

Suicide probability is more related depressive aspect of the bipolar disorder. As for male patients of the manic group, the vast majority showed subclinical suicide probability. There is high frequency of comorbidity between bipolar disorder and panic symptoms that frequently reach the threshold of a comorbid panic disorder with increased suicide probability.

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