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Background The association between suicidal behavior and quality of life (QoL) in bipolar disorder (BD) is poorly understood. Worse QoL has been associated with suicide attempts and suicidal ideation in schizophrenic patients, but this relationship has not been investigated in BD. This study tested whether a history of suicide attempts was associated with poor QoL in a well-characterized sample of patients with BD, as has been observed in other psychiatric disorders and in the general population. Methods One hundred eight patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BD type I (44 with previous suicide attempts, 64 without previous suicide attempts) were studied. Quality of life was assessed using the World Health Organization's Quality of Life Instrument–Short Version. Depressive and manic symptoms were assessed using the Hamilton Depression Rating Scale–17 items and the Young Mania Rating Scale. Results Patients with BD and previous suicide attempts had significantly lower scores in all the 4 domains of the World Health Organization's Quality of Life Instrument–Short Version scale than did patients with BD but no previous suicide attempts (physical domain P = .001; psychological domain P P = .001, and environmental domain P = .039). In the euthymic subgroup (n = 70), patients with previous suicide attempts had significantly lower scores only in the psychological and social domains ( P = .020 and P = .004). Limitations This was a cross-sectional study, and no causal associations can be assumed. Conclusions Patients with BD and a history of previous suicide attempts seem to have a worse QoL than did patients who never attempted suicide. Poorer QoL might be a marker of poor copying skills and inadequate social support and be a risk factor for suicidal behavior in BD. Alternatively, poorer QoL and suicidal behavior might be different expressions of more severe BD.

Background: Lifetime history of suicide attempts is frequently associated with bipolar disorder (BD) and even during remission, patients with bipolar disorder can present social skills deficits. However, no study has been conducted in order to evaluate social skills in bipolar patients with a past history of suicide attempts. Method: We studied a group of 28 euthymic outpatients with BD type I: 12 with a history of suicide attempt and 16 non-attempters subjects. The groups of patients were compared with 31 healthy control in a social skills measure. Results: Patients with a history of suicide attempts presented lower scores for the domains that assessed conversational skills and social self-confidence, social openness to new people and situations and self-control of aggressiveness and individual reactions to aversive stimuli that require the management of anger and aggressiveness when compared with healthy controls and bipolar patients without previous suicide attempts. Conclusions: BPI outpatients with a history of suicide attempts present inhibited behaviour in relation to other people and their environment. Further research may verify if these social skills deficits are associated with other risk factors that may lead to higher suicidality in Bipolar Patients. Key words: bipolar disorder, suicide attempts, social skills, inhibited behaviour. Resumo: Introducao: Tentativas de suicidio ao longo da vida estao frequentemente associadas com transtorno bipolar (TB) e mesmo durante a remissao, pacientes com TB podem apresentar deficits nas habilidades sociais.Entretanto, nenhum estudo explorou ainda as habilidades sociais em pacientes com TB que tem historia passada de tentativas de suicidio. Metodo: Foi estudado um grupo de 28 pacientes com TB tipo I em eutimia: 12 com historia de tentativa de suicidio e 16 que nao tinham tentado suicidio. O grupo de pacientes foi comparado a um grupo controle em uma medida de habilidade social. Resultados: Pacientes com historia de tentativa de suicidio, quando comparados aos controles saudaveis e aos pacientes sem tentativas de suicidio, apresentaram baixos escores nos dominios que avaliavam habilidades de conversacao e desenvoltura social; auto-exposicao a desconhecidos e situacoes novas, e auto controle da agressividade e das reacoes a estimulos aversivos que requerem o manejo da raiva e da agressividade. Conclusoes: Pacientes com TB tipo I com historia de tentativa de suicidio apresentam inibicao do comportamento em relacao as outras pessoas e ao meio ambiente. Pesquisas futuras podem verificar se os deficits nas habilidades sociais estao associados a outros fatores de risco que podem levar a maior suicidalidade em pacientes com TB. Palavras chaves: transtorno bipolar, tentativa de suicidio, habilidades sociais, inibicao do comportamento.

OBJECTIVE: This article reviews the evidence for the major risk factors associated with suicidal behavior in bipolar disorder. METHOD: Review of the literature studies on bipolar disorder, suicidal behavior and suicidal ideation. RESULTS: Bipolar disorder is strongly associated with suicide ideation and suicide attempts. In clinical samples between 14-59% of the patients have suicide ideation and 25-56% present at least one suicide attempt during lifetime. Approximately 15% to 19% of patients with bipolar disorder die from suicide. The causes of suicidal behavior are multiple and complex. Some strong predictors of suicidal behavior have emerged in the literature such as current mood state, severity of depression, anxiety, aggressiveness, hostility, hopelessness, comorbidity with others Axis I and Axis II disorders, lifetime history of mixed states, and history of physical or sexual abuse. CONCLUSION: Bipolar disorder is the psychiatric condition associated with highest lifetime risk for suicide attempts and suicide completion. Thus it is important to clinicians to understand the major risk factors for suicidal behavior in order to choose better strategies to deal with this complex behavior. OBJETIVO: O artigo revisa as evidências relacionadas aos principais fatores de risco associados ao comportamento suicida no transtorno bipolar. MÉTODO: Revisão de artigos da literatura em transtorno bipolar, tentativa de suicídio e ideação suicida. RESULTADOS: O transtorno bipolar está fortemente associado à presença de ideação suicida e a tentativas de suicídio. Em amostras clínicas, entre 14% e 59% dos pacientes apresentam ideação suicida e entre 25% e 56% têm pelo menos uma tentativa de suicídio ao longo da vida. Aproximadamente 15% a 19% dos pacientes com transtorno afetivo bipolar morrem por suicídio. As causas do comportamento suicida são múltiplas e complexas. Alguns preditores de comportamento suicida vêm sendo demonstrados consistentemente na literatura, tais como estado de humor atual, gravidade da depressão, ansiedade, agressividade, hostilidade, presença de comorbidades com outros transtornos do eixo I e eixo II, presença de estados mistos ao longo do curso da doença e história de abuso físico ou sexual. CONCLUSÃO: O transtorno bipolar é o transtorno psiquiátrico com maior risco ao longo da vida para tentativas de suicídio e suicídio completo. Sendo assim é importante para o clínico identificar os principais fatores de risco para comportamento suicida visando a escolha das melhores estratégias para lidar com esse comportamento complexo.