title: Correlates of suicidal ideation in dysphoric mania.
abstract: BACKGROUND
  Previous investigations have reported that suicidal ideation and behavior are more prevalent during mixed than pure mania. Uncertainties exist about whether suicidality in mania arises from multiple concurrent depressive symptoms, or rather, as a categorical phenomenon, reflecting dysphoria without necessarily a full major depression. To elucidate the relationship 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 1991-1995. All had > or = 2 concomitant depressive symptoms (other than suicidality). Affective and psychotic symptoms, past suicide attempts, prior illness, and related clinical/demographic variables were assessed by a standardized protocol.
  
  
  RESULTS
  Suicidal ideation was significantly more common among dysphoric manics who were caucasian, took antidepressant medications in the week prior to admission, had histories of alcohol abuse/dependence, and made past suicide attempts. Suicidal ideation was evident for nearly half of dysphoric manic patients with < or = 3 depressive symptoms who did not meet DSM criteria for a mixed state. No individual manic or depressive symptoms other than dysphoric mood were more common among suicidal than nonsuicidal patients.
  
  
  CONCLUSIONS
  Findings from this retrospective study require confirmation using a prospective assessment. Treatments were naturalistic and may have differentially influenced hospital course and illness characteristics. Factors related to suicide attempts (rare in this cohort) or completions (not a focus of this study) may differ from those related only to suicidal ideation.
  
  
  CONCLUSIONS
  Caucasian dysphoric manic patients with past suicide attempts and substance abuse may have a significantly elevated risk for suicidality, even when full major depression does not accompany mania. Suicidality is a clinically important consideration in a majority of dysphoric manic patients.
authors.affiliation: Weill Medical College of Cornell University, New York, NY, USA. jfgoldbe@mail.med.cornell.edu
authors.forename: J F
authors.initials: JF
authors.lastname: Goldberg
authors.forename: J L
authors.initials: JL
authors.lastname: Garno
authors.forename: L
authors.initials: L
authors.lastname: Portera
authors.forename: A C
authors.initials: AC
authors.lastname: Leon
authors.forename: J H
authors.initials: JH
authors.lastname: Kocsis
authors.forename: J E
authors.initials: JE
authors.lastname: Whiteside
mesh_terms: D000328:Adult; D000339:Affect; D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D003071:Cognition; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D019966:Substance-Related Disorders / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology*; D044465:White People
chemical_list: D000928:Antidepressive Agents