title: Psychotherapeutic intervention and suicide risk reduction in bipolar disorder: a review of the evidence.
abstract: BACKGROUND
  25-50% of bipolar patients attempt suicide at least once in their lifetime and completed suicide in this population is about 1% annually, about 60 times the rate of the general population. Psychotherapy may be an effective adjunctive option in preventing suicide in bipolar patients. It has been suggested that interpersonal, cognitive and behavioural techniques may be effective in controlling mood shifts, increasing compliance with pharmacotherapy, and maintaining morale in the face of therapeutic adversity and incomplete response. The aim of our study was to systematically review the literature concerning the efficacy of psychosocial interventions in reducing the risk for attempting or committing suicide.
  
  
  METHODS
  We searched MEDLINE with the combination of the key words 'psychotherapy' or 'psychoeducation' or 'cognitive therapy' or 'behavio(u)ral therapy', 'cognitive-behavio(u)ral' or 'family therapy' or 'social rhythm' or 'rhythm' with 'suicide' and 'bipolar', limited to English language papers published between 1990 and January 2008. Papers were selected based on the criterium that they provided definite data on the role of psychotherapy in suicide prevention, and specifically in bipolar disorder.
  
  
  RESULTS
  Our search returned 481 references, of which 17 were selected based on the above criteria. The selected papers were classified according to the area of suicide prevention they were dealing with as 1. Psychosocial and demographic factors, 2. Psychological profile and 3. Efficacy of psychotherapies.
  
  
  CONCLUSIONS
  Our paper summarizes specific features and correlates of suicide in bipolar patients and possible targets of psychosocial intervention in the prevention of suicide in bipolar patients. Although studies researching the effect of psychosocial interventions on suicidal behaviour are virtually non-existent, hard data concerning the effectiveness of psychosocial interventions in bipolar disorder are emerging, but still suffer from methodological drawbacks.
authors.affiliation: 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Fountoulakis
authors.forename: Xenia
authors.initials: X
authors.lastname: Gonda
authors.forename: Melina
authors.initials: M
authors.lastname: Siamouli
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Rihmer
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011584:Psychology; D011613:Psychotherapy / Q000379:methods*; D040242:Risk Reduction Behavior; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology*