Experts call for action to reduce suicide in bipolar I

Mania with depressive symptoms in bipolar I is known to affect as many as 64% of patients with mania.¹ As well as a higher risk of suicide, it also leads to more frequent episodes of longer duration, more frequent relapses, a longer time to reach symptomatic remission as well as more severe symptoms of anxiety, irritability and agitation (AIA).²

We need to increase awareness of identification of the symptoms of AIA, said Professor Eduard Vieta, Director of the Bipolar Disorders Program of the Hospital Clinic at the University of Barcelona, Spain. “It is important to ensure that patients experiencing mania with depressive symptoms are diagnosed quickly and accurately.

“We now understand that almost three quarters (72%) of patients experiencing mania with depressive symptoms report symptoms of anxiety, irritability or agitation. Simple recognition of these hallmarks can enable healthcare professionals to intervene, treat patients and thus reduce the hospitalisations that often cost healthcare economies billions of euros. Costs aside, this couldpotentially save thousands of lives worldwide.”

Financial burden

In addition to the significant impact on patients, carers and the family of bipolar I patients, the financial burden to society of bipolar I disorder and mania with depressive symptoms is huge. In Europe it is estimated to exceed 21.5 billion Euros,³  whilst in the USA figures are approximately $151 billion per annum.⁴

Some studies have shown that most of the costs derived from mania with depressive symptoms in bipolar I disorder are related to hospitalization (45%) followed by medical treatment (20%) and psychiatric visits (19%). The indirect costs are even higher: up to four times greater than the direct costs. Typically these are related to lost productivity, absenteeism and unemployment.⁵

Suicide and attempted suicides also carry a particularly heavy financial burden. In the US, for every suicide there are 5 hospitalisations and 22 emergency department visits for suicidal behavior. In 2010 this meant more than 844,000 visits and almost 192,000 hospitalisations.

“Clearly in addition to the financial costs, suicide causes huge emotional distress and suffering to friends and relatives. The emotional impact may also carry some mental health problems amongst the relatives. So our call to action is to improve levels of education and awareness of bipolar I disorder and particularly mania with depressive symptoms and to ensure a broader recognition of the symptoms that help and lead us to assess the diagnosis of mania with depressive symptoms. Those symptoms are anxiety, irritability and agitation. We would recommend routine assessments of patients with these symptoms during mania and we’d like to foster research in this area of the disorder.”

Preventing suicide

“Lack of education, awareness and understanding of suicide has led us to be ill-prepared in dealing with suicide,” said Professor Maurizio Pompili, Professor of Suicidology, Faculty of Medicine and Psychology of Sapienza University, Italy, who contributed to the report. “We must learn some facts to help prevent suicide and assess mania with depressive symptoms which is associated with more frequent suicidal thoughts.”

Next Professor Pompili outlined some useful steps to help reduce the incidence of suicide:

• Empathic assessment of suicidal behavior
• Identify and treat mania with depressive symptoms
• Use treatment with broad efficacy to reduce the risk of suicide
• Treatment of comorbidities
• Restricted access to lethal methods
• Involvement of significant others
• Psychotherapy
• Planning of rescue strategies
• Psychoeducation to help treat and prevent mania with depressive symptoms

Recognition for family caregivers

“We also need to remember to include family and friends. A joint effort is key to saving the lives of people suffering episodes of mania with depressive symptoms in bipolar I,” said Prof Pompili. “We must also do our best to offer hope to these patients. Even if we reduce just a little bit of psychological pain you can help to save lives.”

The next speaker Bert Johnson spoke on behalf of patients and carers of families with mental illness. President of European Federation of Associations of Families of People with Mental Illness (EUFAMI), Mr Johnson explained that their key mission was to ensure that family caregivers are fully represented and integrated as part of the whole community of professionals, social workers and clinicians who have responsibilities for diagnosing and treating people with mental illness.”

“We have yet to accomplish this mission in full. We want to make sure that the voice of family caregivers is properly recognized because they bring expertise, knowledge and commitment, which is not to be found elsewhere.”