title: Is there an association between suicide attempt and delay of initiation of mood stabilizers in bipolar I disorder?
abstract: BACKGROUND
  Little is known about the extent to which delay of initiation of mood-stabilizing treatment may influence outcomes in bipolar patients (BP). In this study, our aim was to investigate the association between delay of mood stabilizer treatment in bipolar patients and lifetime history of suicide attempts.
  
  
  METHODS
  A consecutive sample of 268 bipolar I outpatients from two teaching hospitals in Brazil was recruited. The assessment included a socio-demographic history form, a clinical interview regarding clinical variables and the Structured Clinical Interview for DSM-IV. Participants were divided into three groups: BP that initiated the first mood stabilizer in the same year of the first episode of the disease (FMS≤1), between 1 and 5 years after the first episode of the disease (1<FMS≤5), and after 5 years after the first episode of BD (FMS>5).
  
  
  RESULTS
  The mean time from the first episode until the first mood stabilizer medication was 8.6 years (SD 9.8 years). The FMS>5 group, showed a higher lifetime prevalence of suicide attempts than the other two groups (PR=1.75, 95% CI: 1.24-2.47), p=0.001. These results remained significant after adjusting for potential confounders, (PR=1.82, 95% CI: 1.29-2.60), p=0.001.
  
  
  CONCLUSIONS
  This study evaluated patients retrospectively and does not permit a cause-effect relationship.
  
  
  CONCLUSIONS
  The present study supports the importance of early diagnosis and early intervention for BP in order to limit the potentially lethal impact of the disease.
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), University Hospital, and Programa de Pós-graduação em Medicina e Saúde, Universidade Federal da Bahia, Brazil. fabiana.nery@hotmail.com
authors.forename: Fabiana
authors.initials: F
authors.lastname: Nery-Fernandes
authors.forename: Lucas C
authors.initials: LC
authors.lastname: Quarantini
authors.forename: José L
authors.initials: JL
authors.lastname: Guimarães
authors.forename: Irismar R
authors.initials: IR
authors.lastname: de Oliveira
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
authors.forename: Ângela
authors.initials: Â
authors.lastname: Miranda-Scippa
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012189:Retrospective Studies; D013406:Suicide, Attempted; D013997:Time Factors
chemical_list: D011619:Psychotropic Drugs