Review Question - QID 206927

Patients experiencing a mixed episode have the highest incidence of suicide attempts.

Studies indicate that up to 50% of patients with bipolar I disorder attempt suicide at some point during their lifetime, and up to 20% will complete suicide. Among the different mood states, mixed episodes have the highest rate of concurrent suicide attempts. It is thought that patients experiencing manic episodes do not have the desire to commit suicide, and patients experiencing depressive episodes do not have the volition to carry out an attempt. In contrast, patients experiencing a mixed episode may have both the desire to commit suicide and the volition to carry out a plan.

Price and Marzani-Nissen discuss the management of bipolar disorder. They reiterate that the risk of suicide in patients with bipolar disorder is more than 20 times that of the non-affected population. In addition, they note that patients with untreated bipolar disorder have a significantly increased risk of death from cardiovascular causes.

Swann et al. discuss the characteristics of mixed episodes. They note that although the rates of suicidal ideation are equal in mixed and depressive episodes, rates of suicide attempts are significantly increased during mixed episodes. In addition, patients that experience mixed episodes have a significantly worse long-term prognosis than those with purely manic-depressive symptoms.

Incorrect Answers:
Answer 1: Patients experiencing manic episodes do not usually have suicidal ideation.
Answer 2: Although rates of suicidal ideation are equal in mixed and depressive episodes, rates of suicide attempt are significantly higher during mixed episodes.
Answer 4: Mixed episodes have a higher associated rate of suicide attempts.
Answer 5: Patients with bipolar disorder have a 20-fold increased risk of attempting suicide than the non-affected population.