What characteristics of mania with depressive symptoms do you think are to blame for the higher risk of suicide seen in sufferers of the condition?
Certainly when we see a mixed state, where we can observe both depressive and manic symptoms, the risk of suicide is elevated. I believe I would rank the agitation first. I would also rank very highly the problems with sleep, which these patients report.
What special precautions would you take to lower the risk of suicide in patients diagnosed with mania with depressive symptoms?
Agitation is probably responsible in a number of cases for suicidality in those patients. So certainly I would do everything to treat agitation and certainly there we need medication, which would primarily treat mania or depression, or both, which could be used also for the treatment of agitation. I am talking about short-term usage and acute risk of suicidality.