title: Cognitions in bipolar affective disorder and unipolar depression: imagining suicide.
abstract: OBJECTIVE
  Bipolar disorder has the highest rate of suicide of all the psychiatric disorders. In unipolar depression, individuals report vivid, affect-laden images of suicide or the aftermath of death (flashforwards to suicide) during suicidal ideation but this phenomenon has not been explored in bipolar disorder. Therefore the authors investigated and compared imagery and verbal thoughts related to past suicidality in individuals with bipolar disorder (n = 20) and unipolar depression (n = 20).
  
  
  METHODS
  The study used a quasi-experimental comparative design. The Structured Clinical Interview for DSM-IV was used to confirm diagnoses. Quantitative and qualitative data were gathered through questionnaire measures (e.g., mood and trait imagery use). Individual interviews assessed suicidal cognitions in the form of (i) mental images and (ii) verbal thoughts.
  
  
  RESULTS
  All participants reported imagining flashforwards to suicide. Both groups reported greater preoccupation with these suicide-related images than with verbal thoughts about suicide. However, compared to the unipolar group, the bipolar group were significantly more preoccupied with flashforward imagery, rated this imagery as more compelling, and were more than twice as likely to report that the images made them want to take action to complete suicide. In addition, the bipolar group reported a greater trait propensity to use mental imagery in general.
  
  
  CONCLUSIONS
  Suicidal ideation needs to be better characterized, and mental imagery of suicide has been a neglected but potentially critical feature of suicidal ideation, particularly in bipolar disorder. Our findings suggest that flashforward imagery warrants further investigation for formal universal clinical assessment procedures.
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, UK. susie.hales@psych.ox.ac.uk
authors.forename: Susie A
authors.initials: SA
authors.lastname: Hales
authors.forename: Catherine
authors.initials: C
authors.lastname: Deeprose
authors.forename: Guy M
authors.initials: GM
authors.lastname: Goodwin
authors.forename: Emily A
authors.initials: EA
authors.lastname: Holmes
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology*; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007092:Imagination / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D013405:Suicide / Q000523:psychology*; D011795:Surveys and Questionnaires
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