title: A review of panic and suicide in bipolar disorder: does comorbidity increase risk?
abstract: BACKGROUND
  Bipolar mood disorder carries a serious suicide risk. Panic disorder, which also confers an independent risk of suicide and psychiatric comorbidity, in general has been found to amplify suicidality in mood-disordered patients. This article assesses the available literature on how panic and suicide relate to each other in bipolar mood-disordered patients.
  
  
  METHODS
  We conducted a search on Medline and PsycINFO using the keywords "anxiety", "attempted suicide", "completed suicide", "mortality", "self-harm" in combination with "bipolar", "manic depression" and "panic". Twenty-four articles were included in the evaluation.
  
  
  RESULTS
  14 papers support increased risk, 9 papers do not support increased risk, and 3 papers are inconclusive.
  
  
  CONCLUSIONS
  The presence of comorbid panic disorder in individuals with bipolar disorder may confer an increased risk of suicide risk. Some papers' reviewed have conflicting conclusions but the majority of papers support an increased risk. This is consistent with a recent (2008) literature review supporting increased risk of suicide in bipolar patients with comorbid anxiety disorders. Future research should study specific bipolar subgroups, focus on anxiety and panic symptoms rather than diagnosis, and look at the role of specific pharmacological treatment in patients with comorbid mood and anxiety disorders.
authors.affiliation: Beth Israel Medical Center, Department of Psychiatry, NYC, NY, United States. ekilbane@chpnet.org
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Kilbane
authors.forename: N Simay
authors.initials: NS
authors.lastname: Gokbayrak
authors.forename: Igor
authors.initials: I
authors.lastname: Galynker
authors.forename: Lisa
authors.initials: L
authors.lastname: Cohen
authors.forename: Susan
authors.initials: S
authors.lastname: Tross
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D006801:Humans; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D018570:Risk Assessment; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data