ÖZET:
İntihar girişimi olan ve olmayan İki Uçlu Bozukluk hastalarında mizaç-karakter özel-likleri, dürtüsellik ve işlevsellik düzeyleri: Kontrollü bir çalışma
Amaç: Bu çalışmada; İki Uçlu Bozukluk (İUB) hastalarında intihar girişimi öyküsü olan ve olmayan hastaların mizaç karakter özellikleri ile dürtüsellik ve işlevsellik düzeylerinin karşılaştırılması amaçlandı.
Yöntem: Çalışmaya Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi psikiyatri polikliniğine baş-vuran 101 İUB hastası ile yaş ve cinsiyet açısından eşleş-tirilmiş 50 sağlıklı bireyden oluşan kontrol grubu alındı. Hasta ve kontrol grubuna DSM-IV Eksen-I Bozuklukları için Yapılandırılmış Klinik Görüşme Ölçeği (SCID-I), Mizaç ve Karakter Envanteri (MKE), Barratt Dürtüsellik Ölçeği-11 (BDÖ-11) uygulanırken, hasta grubuna ek olarak Hamilton Depreyon Ölçeği (HAM-D), Young-Mani Derecelendirme Ölçeği (YMDÖ), İki Uçlu Bozukluk İşlevsellik Ölçeği (İUBİÖ) uygulandı.
Bulgular: Hasta ve kontrol grubu arasında sosyodemog-rafik özellikler açısından anlamlı bir fark yoktu (p<0,05). Hasta grubun yaş ortalaması 35,69±12,10, kontrol gru-bunun yaş ortalaması 32,00±9,24 idi. Hasta grupta 38 (%37,62) kişinin intihar girişiminde bulunduğu saptandı. İntihar girişiminde bulunan hasta grubu ile intihar girişimi olmayan hasta grubunun sağlıklı kontrol grubu ile karşı-laştırılması sonucu; işbirliği yapma (İY), kendini yönetme (KY), kendini aşma (KA), yenilik arayışı alt grubu (YA2), zarardan kaçınma alt grubu (ZK4), ödül bağımlılığı alt grubu (ÖB2), BİÖ, BDÖ toplam skorlarında gruplar arasında anlamlı fark vardı.
Tartışma: Araştırmamızda intihar girişimi olan hasta gru-bunun, kişilik patolojilerine yatkınlığı gösteren İY, KY skor-larının anlamlı olarak düşük bulunması İUB hastalarında kişilik bozukluklarının intihar girişimi ile ilişkili olabileceğini düşündürmüştür. Ayrıca intihar girişimi olan hasta grubu-nun dürtüsellik düzeylerinin daha yüksek çıkması ve iki uçlu bozukluk işlevsellik düzeylerinin daha düşük olması intihar girişiminin bu hastalarda işlevsellik düzeylerini daha bozduğunu, intiharın bu hastalarda daha dürtüsel olarak ortaya çıkmış olabileceğini göstermiştir.
Anahtar sözcükler: iki uçlu bozukluk, mizaç ve karakter, intihar, dürtüsellik, işlevsellik
Journal of Mood Disorders 2015;5(1):8-15
ABS TRACT:
Temperament-character features, levels of impulsiveness and functionality in bipolar disorder patients with and without suicide attempts: A controlled study
Objective: In this study, we aimed to compare temperament-character features, impulsiveness and functionality levels of bipolar patients who attempted suicide and who did not.
Methods: One hundred one patients admitted to Erenköy Mental Health Training and Research Hospital who were diagnosed with bipolar disorder according to DSM-IV-TR and 50 healthy age and gender-matched controls are included in this study. We applied Sociodemographical and Clinical Data Form and Diagnostic and Statistical Manual of Mental Disorders Axis-I Structured Clinical Interview for DSM-IV (SCID-I), Temperament and Character Inventory (TCI), Barratt Impulsiveness Scale-11 (BIS-11) to both patient and control groups; Hamilton Rating Scale for Depression (HRSD), Young Mania Rating Scale (YMRS), Bipolar Disorder Functioning Questionnaire (BDFQ) to only patient group. Results: There was not any statistically significant difference in sociodemographic features between the patient and control group (p>0.05). Mean age of the patient group was 35,69±12,10, mean age of the control group was 32,00±9,24. 38 individuals (%37,62) in the patient group were found to have one or more suicidal attempts. In the comparison between the patient group that attempted suicide and the patient group without suicidal attempt, statistically significant differences were found in cooperativeness (C), self-directedness (SD), self transcendence (ST), novelty seeking subgroup (NS2), harm avoidance subgroup (HA4), reward dependency subgroup (RD2) and total scores of BDFQ and BIS-11.
Discussion: In our study, the statistically significant lower C and SD scores found in suicide attempters, which points out tendency to personality disorders, suggests that personality disorders might be associated with suicide attempts in bipolar disorder patients. In addition to this, higher impulsiveness and lower bipolar functionality scores that found in suicide attempters suggests that these suicide attempts might be more impulsive attempts and impair patients functionality.
Key words: bipolar disorder, temperament and character, suicide, impulsiveness, functionality
Journal of Mood Disorders 2015;5(1):8-15
Temperament-Character Features, Levels of
Impulsiveness and Functionality in Bipolar Disorder
Patients with and Without Suicide Attempts:
A Controlled Study
Filiz İzci
1, Selma Bozkurt Zincir
1, Serkan Zincir
2, Rabia Bilici
1, Murat Yalçın
1, Ayşe Terzi
1,
Tuğba Göncü
1, Özgür Akdur
1, Şakir Gıca
1, Ümit Başar Semiz
31Dr., Psikiyatri Bölümü, Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Istanbul-Turkey
2Dr., Piskiyatri Bölümü, Gölcük Askeri Hastanesi, İzmit-Turkey
3Dr., Psikiyatri Bölümü, Muğla Üniversitesi Hastanesi, Muğla-Turkey
Ya zış ma Ad re si / Add ress rep rint re qu ests to: Filiz İzci,
Psikiyatri Bölümü, Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Istanbul-Turkey
Elekt ro nik pos ta ad re si / E-ma il add ress: [email protected]
Ka bul ta ri hi / Da te of ac cep tan ce: 3 Aralık 2014 / December 3, 2014
Bağıntı beyanı:
F.İ., S.B.Z., S.Z., R.B., M.Y., A.T., T.G., Ö.A., Ş.G., Ü.B.S.: Yazarlar bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemişlerdir.
Declaration of interest:
INTRODUCTION
Suicidal behavior is any action directed toward oneself that could result in death. It is accepted that there are multiple factors involved in the occurrence of suicidal behavior, some of which include the following: various aspects of personality, despair, decreased social support, biological tendencies and disorders, existence of life stressors, mood disorders and familial burden of suicidal behavior (2). In addition, psychiatric disorders such as depression, bipolar disorder, substance abuse disorders and schizophrenia play an important role in suicidal behavior (3). It has been reported that individuals who have co-morbid personality disorders and psychiatric disorders have statistically significantly increased risk of suicidal behavior (4,5). The suicide rate among bipolar disorder patients is 30 times higher than among the general population. Approximately 15–25% of bipolar disorder patients attempt suicide and 15% of these attempts result in death. The suicide rate of bipolar depression patients is 35 times higher than bipolar manic episode patients (6). Personality disorders are widely accompanied with suicidal behavior with a rate of 31–77%. In studies that evaluate personality traits of individuals who attempted suicide, common characteristics include being immature, egocentric, dependent, and having poor impulse control (7). In studies which aim to examine the association between suicidal attempts and temperament and character, the identified character features point out that individuals who attempted suicide have low self directedness (8–12) and high transcendence (10,12); temperament features show that they have high harm avoidance (9–12), novelty seeking (13) and reward dependency points. Studies on bipolar disorder patients have shown that when comparing between depression patients and healthy individuals, the novelty seeking values of depression patients are generally higher (14) while their persistence (15) points are lower. While high novelty seeking and harm avoidance points are found to be associated with cluster B and cluster C personality disorders (16), these features have also been found to be associated with the risk of suicide in bipolar affective disorder patients (17). High novelty seeking points are thought to be an indicator of impaired functionality during long-term surveillance (18). In this study, we aimed to compare temperament and character features with the impulsiveness and functionality levels of the bipolar disorder patients that attempted suicide as well as those that did not.
METHODS
Sample
One hundred one patients admitted to Erenköy Mental Health Training and Research Hospital between March 2013-August 2013 who diagnosed with bipolar disorder using Structured clinical interview for DSM-IV axis I disorders (SCID-I) and 50 healthy age and gender matched controls without a past or present history of neurological or psychiatric disease are included in this study. Informed verbal and written consent was obtained from each participant. The study was performed after approval from Erenköy Mental Health Training and Research Hospital Ethics Committee was obtained.
The individuals included in this study are aged 18-60 years, can read and write properly, have been diagnosed with bipolar disorder according to DSM-IV-TR, have been in remission for at least 2 months with a Hamilton Depression Rating Scale [HAM-D] score lower than 7 and an Young Mani Rating Scale [YMRS] score lower than 5. Impulsivity and temperament characteristics were evaluated during remission period.
Individuals with mental retardation, alcohol-substance usage associated disorders, anxiety disorders, schizophrenia and other psychotic disorders, dementia and other cognitive disorders, diseases which are associated with specific personality features such as epilepsy, migraine, multiple sclerosis and Parkinson’s disease, systemic diseases, vision loss, hearing loss and diseases affecting motor abilities are excluded from the study.
Materials
Data Collection Tools
Structured Clinical Interview for DSM-IV for AXIS I Disorders/ Clinical Version (SCID-I/CV): SCID-I is a structured clinical interview for Axis 1 disorders which was created by First et al. in 1997 (19). Validity and reliability studies for Turkey were conducted by Çorapçıoglu in 1999 (20).
Temperament and Character Inventory (TCI): TCI is a self-report scale that is used for evaluating personality. It consists of 240 ‘true’ or ‘false’ questions. TCI has 7 higher order scales. Except the K scale, all other scales are divided into 3–5 sub-scales. In the temperament group, there are 4 NS, 4 HA and 4 RD sub-scales. In the character group, there are 5 SD and 3 ST sub-scales (21). Validity and reliability studies for Turkey were conducted by Köse et al. in 2004 (22).
Barratt Impulsiveness Scale-11 (BIS-11): Developed for measuring impulsiveness, BIS is a 30-item self report scale. Patients choose the best answer from among the following answers: never, occasionally, frequently and always. The following three factors can be obtained by factor analysis: 1) attentional impulsiveness, 2) motor impulsiveness and 3) non-planning impulsiveness. Higher scores indicate a high level of impulsiveness. Validity and reliability studies for Turkey were conducted by Güleç et al. in 2008 (24).
Hamilton Rating Scale for Depression (HRSD):
Developed in 1978 by Williams, this is the most commonly
used rating scale for depression (25). The arithmetical sum of each item’s score gives the total score of the scale. A score of 0–7 is considered to be normal. Scores between 7–17 indicates moderate, 18–24 indicates severe and 25 and above indicates very severe depression. Validity and reliability studies for Turkey were conducted by Akdemir et al. in 1996 (26).
Young Mania Rating Scale (YMRS): Developed by Young el al., this scale is used for measuring the severity of manic episodes (27). The scale has 11 items; 7 of them are five-point Likert-type items and 4 of them are nine-point Likert-type questions. The lowest score is 0 and the highest score is 44. Validity and reliability studies for Turkey were conducted by Karadag et al. in 2001 (28). The cut-off point of the Turkish version has not been determined. In this study, each item’s scores and total scores are compared between genders.
Bipolar Disorder Functioning Questionnaire (BDFQ): This is a 52-item self-report questionnaire that is used for assessing the functionality levels of bipolar disorder patients within the acute phase and remission. The questionnaire was developed by Akdemir et al. in 2007 (29). It is composed of 11 sub-scales that include emotional functionality, mental functionality, sexual functionality, feeling of stigmatization, introversy, inner house relations, relations between friends, attendancy to social events, daily activities and hobbies, taking initiative, using potential and job/occupation. The scale does not have a cut-off point, so its usage is recommended in comparison studies.
Tab le 1: Socio-demographic characteristics of the patients and controls
Patient (n=101) Control (n=50) Statistic
χ2
/t P
Age (Mean±SD) 35.69±12.10 32,00±9,24 1.89 0.06
Gender
Male 71 (70.3) 30 (60.0) 1.60 0.20
Female 30 (29.7) 20 (40.0)
Educational status
Primary school 34 (33.6) 8 (16.0) 5.40 0.06
High school 32 (31.7) 15 (30.0)
University 35 (34.7) 27 (54.0)
Marital status
Married 41 (40.6) 18 (36.0) 1.60 0.20
Single 60 (59.4) 32 (64.0)
Occupational status
Employed 67 (66.3) 30 (60.0) 10.94 0.06
Unemployed 27 (26.7) 10 (20.0)
Student 7 (6.90) 10 (20.0)
Statistical Analysis
Statistical package for the social sciences (SPSS) for Windows 18.0 is used for statistical analyses of the data in this study. The Pearson chi-square test is used for analyzing the categorical type of variable. After testing groups for normal distribution and homogeneity, Student’s t test is performed to evaluate mean differences in temperament and impulsivity. One-way ANOVA and post-hoc tukey test are used to analyze patient subgroups. Results were expressed as mean and standard deviation. The confidence interval is 95% and a value of p<0.05 is accepted as statistically significant.
RESULTS
The mean age of the patient group was 35,69±12,10, while the mean age of the control group was 32,00±9,24. In terms of gender, 70,3% of the patient group and 60% of the control group was male. With respect to employment, 26,7% of the patient group and 20% of the control group was unemployed. There was not any statistically significant difference in sociodemographic features between the patient and control group (p>0.05) (Table 1).
In the comparison of the patient group with suicide attempts, the patient group without suicide attempts and the
Tab le 2: Comparison of TCI scores of patients in bipolar patients with or without suicide attempt and healthy groups
Group with suicide attempt (n=38) (I) Mean±SD
Group without suicide attempt (n=63) (II) Mean±SD
Control group (n=50) (III) Mean±SD
Statistic
Comparison
F** p*
Novelty seeking
NS1 5.86±2.29 5.60±1.80 6.34±2.03 0.67 0.07 I=II=III
NS2 4.58±1.93 4.44±2.19 3.14±1.97 6.97 0.00* I=II>III
NS3 5.36±2.64 4.83±2.25 4.88±1.49 0.64 0.61 I=II=III
NS4 3.81±1.73 4.34±1.96 4.24±1.66 1.07 0.57 I=II=III
Total 19.7±2.29 19.23±5.19 18.60±4.83 0.30 0.87 I=II=III
Harm avoidance
HA1 5.40±2.26 6.09±2.70 5.02±2.055 2.30 0.33 I=II=III
HA2 3.82±1.61 3.54±1.81 3.64±1.508 0.01 0.73 I=II=III
HA3 3.31±2.29 2.78±2.35 3.08±1.382 0.93 0.54 I=II=III
HA4 4.54±2.09 4.32±2.26 3.48±1.528 2.08 0.03* I=II>III
Total 16.84±6.42 16.22±7.52 15.22±3.72 0.22 0.31 I=II=III
Reward dependency
RD1 6.68±2.16 7.31±1.80 7.63±1.39 2.67 0.19 I=II=III
RD2 4.92±1.79 3.97±1.57 4.13±1.88 3.07 0.01* I>II=III
RD3 2.80±1.30 2.21±1.07 2.65±1.52 0.60 0.08 I=II=III
Total 14.30±3.69 13.65±2.57 14.28±3.43 0.29 0.38 I=II=III
Perseverance
P 5.08±2.02 5.10±2.32 5.16±1.85 0.00 0.91 I=II=III
Self directedness
SD1 4.07±2.08 4.47±2.04 5.58±1.73 4.53 0.00* I=II<III
SD2 4.91±2.29 5.12±1.75 6.58±1.57 15.72 0.00* I=II<III
SD3 2.74±1.49 2.83±2.29 3.78±1.09 7.37 0.00* I=II<III
SD4 4.70±2.51 5.69±2.52 5.76±2.55 2.55 0.24 I=II=III
SD5 6.52±2.24 6.53±2.22 8.40±1.93 9.91 0.00* I=II<III
Total 22.94±1.80 24.14±8.00 30.10±6.22 6.39 0.01* I=II<III
Cooperativeness
C1 5.23±1.99 5.84±1.71 6.46±1.40 5.81 0.03* I=II<III
C2 4.04±1.04 4.04±1.34 4.70±1.32 4.01 0.04* I=II<III
C3 4.61±1.33 4.72±1.51 5.48±1.18 4.07 0.03* I=II<III
C4 6.55±2.35 7.19±2.21 6.82±1.99 0.14 0.41 I=II=III
C5 6.31±1.72 6.78±1.47 7.54±1.03 4.12 0.00* I=II<III
Total 26.74±7.23 28.57±6.34 31.00±4.12 4.83 0.03* I=II<III
Self transcendence
ST1 6.72±2.75 6.56±2.64 5.26±2.34 3.74 0.02* I=II>III
ST2 6.04±2.42 5.38±2.09 4.06±1.95 11.44 0.00* I=II>III
ST3 7.68±2.86 7.64±2.90 7.30±3.11 0.15 0.87 I=II=III
Total 20.44±6.13 19.58±5.66 16.62±6.03 3.88 0.03* I=II>III
*: Post hoc. assessment tukey test, *: p<0.05, **: F: ANOVA test value.
control group, 38 patients were found to have one or more suicide attempts. In terms of temperament, the patient group with suicidal attempts was found to have statistically significantly higher scores of novelty seeking (NS2), harm avoidance (HA4), reward dependency (RD2) (respectively: F=3.07, p<0.00; F=2.08, p<0.05; F=6.97, p<0.01)
In terms of character, the patient group with suicide attempts was found to have statistically significantly lower scores in both self-directedness subgroups (SD1, SD2, SD3, SD5) (F=4.53, p<0.00; F=15.72, p<0.00; F=7.37, p<0.00; F=9.91, p<0.00 ) and total self-directedness (SD) (F=6.39, p<0.01). There were statistically significant differences between groups in the cooperativeness subgroups (C1, C2, C3, C5) (respectively, F=5.81, p<0.05; F=4.01, p<0.05, F=4.07, p<0.05; F=4.12, p<0.00) and in the total cooperativeness scores (C) (F=4.83, p<0.05), self-transcendence (ST1, ST2) (respectively, F=3.74, p<0.05; F=11.44, p<0.00) and total self transcendence scores (ST) (F=3.88, p<0.05) (Table 2).
According to the BIS, the attentional impulsiveness, motor impulsiveness and non-planning impulsiveness
sub-group scores were found to be statistically significantly higher in patients with suicidal attempts (respectively F=17.32, p<0.00; F=24.5, p<0.00; F=18.62, p<0.00) (Table 3).
In the comparison of the functionality of bipolar patients, patients with suicide attempts were found to have higher scores in introversy and feelings of stigmatization and lower scores in attending to social events and inner house relations (p<0.01) (Table 4).
DISCUSSION
Suicide attempt is a common complication among all psychiatric patients. It has been shown that 90% of those who attempt suicide already have a psychiatric disorder (30– 32). The most risky group among all psychiatric disorders is those patients with mood disorders with a rate of 60%. The rate of death by suicide is 20% among those with bipolar disorder, 15% among those with unipolar depression, 18% among alcohol use disorder, 10% among those with schizophrenia and 5–10% among those with personality Tab le 3: Comparison of impulsivity in bipolar disorder patients with or without suicide attempt
BIS-11
Group with suicide attempts (I) Mean±SD
Group without suicide attempts (II) Mean±SD
Control group (III)
Mean±SD
Statistic
Comparison
F** p*
Total 71.60±18.53 64.79±17.43 55.86±7.86 16.83 0.00* I>II>III
Non-planning 29.09±25.29 26.02±4.26 22.66±3.77 18.62 0.00* I>II>III
Motor 24.36±6.22 22.06±5.52 18.82±4.66 24.50 0.00* I>II>III
Attentional 18.15±4.45 16.71±4.55 14.38±3.12 17.32 0.00* I>II>III
*: Post hoc. assessment tukey test, *:p<0.00, **: F: ANOVA test value.
Group with suicidal attempts: I, Group without suicidal attempts: II, Control group: III
Tab le 4: Comparison of functionality in bipolar patients with or without suicide attempts
Group with suicide attempts (n=38)
Mean±SD
Group without suicide attempts (n=63)
Mean±SD
Statistic
t P
Emotional functionality 6,16±2,89 6,42±3,08 -0,38 0,84
Intellectual functionality 3,19±2,22 3,44±2,35 -0,50 0.55
Sexual functionality 4,51±1,05 4,21±1,04 1,23 0.13
Felling of stigmatization 8.17±2.73 6.41±3.06 0.31 0.01*
Introversy 7.36±1.52 6.82±1.70 0.16 0,01*
Inner house relations 12.9±3.10 14.65±2.79 0.11 0,01*
Relations with friends 3,19±2,23 3,44±2,32 -0,50 0.56
Attendancy to social events 14.35±3.92 16.46±3.78 0.36 0,01*
Daily activities and hobbies 3,62±1,13 3,85±1,09 -0,90 0.52
Taking initiative and using potential 4,51±1,07 4,22±1,04 1,22 0.13
Occupation status 3,76±1,96 3,97±2,09 -0,46 0.68
disorders (33–37). It has been shown that the suicide rate of bipolar disorder patients is 20 to 30 times higher than the normal population; in fact, 25–50% of bipolar patients have one or more suicide attempt in their lives and 10–15% of such patients die because of suicide (38). We also found in our study that 38 of the patients (37.62%) have suicide attempts in their lives.
There are a lot of predictive factors of suicide attempt in bipolar disorder patients, one of which is personality features. Cloninger suggested a general psycho-biological theory to describe the structure and the development of personality. He developed a model that describes the following two fundamental components of the personality: temperament and character. Cloninger’s psycho-biological theory regarding temperament includes novelty seeking (NS), harm avoidance (HA), reward dependency (RD) and persistence (P); the character features of his theory include directedness (SD), cooperativeness (C) and self-transcendence (ST). Temperament features points out the hereditary and biological side of personality. Temperament differs from character due to individual diversities in interpersonal and object relations. Character traits on the other hand, can be affected by life events, culture and social learning (39,40,41,21). In some studies that evaluate the association between suicide attempts and temperament and character, the character features of patients with suicide attempts demonstrate low SD (13,17) and high ST (15,17) scores; in terms of temperament features, such patients have high HA, NS and RD scores (13,14,16, 21, 22). In another study, high HA scores were found to be associated with suicide attempts in bipolar disorder patients (42).
Individuals that have high novelty seeking scores are described as ‘impulsive, curious, excited, quick tempered, consumptive and unsteady’ persons, while individuals with low scores are described as ‘mindful, loyal, strict, even-tempered, steady and persistive’. Individuals with high harm avoidance scores are described as ‘careful, nervous, anxious, fearful, shy and easily bored’, while individuals with low scores are described as ‘self-confident, calm, hopeful, light-hearted, energetic and extrovert’. Individuals with high reward dependency scores are described as ‘ambitious, emotional and persistive’, while individuals with low scores are described as ‘independent, stubborn and indecisive’ (40). In our study, we also found high HA4, NS2 and RD2 scores like other studies.
In the literature, high harm avoidance scores have been
found to be especially associated with cluster C personality disorders (43,44). Cloninger et al. suggested that low self-directedness and cooperativeness scores might predict the development of personality disorders (40). Individuals with low self-directedness scores are described as ‘accusatory, aimless, unskilled, undisciplined’, while individuals with low cooperativeness scores are described as ‘strict, judgmental and opportunist’ (21,40,41). One study found the completed suicide rate of individuals with personality disorders to be 29–57% (45). Individuals that have less than 20 points in the temperament and character inventory are diagnosed as having a personality disorder because of poor self-directedness. Furthermore, these individuals have difficulties with taking responsibility, choosing meaningful aims, finding solutions for alterations, accepting boundaries and disciplining habits (44). In our study, especially in the patient group with suicide attempts, the mean SD and C scores were found to be close to the level of pathological personality scores.
Suicide attempt rates of bipolar affective disorder patients are higher than unipolar depressive disorder patients (46). It has been shown that there are two main differences between bipolar disorder patients who have attempted suicide and those who have not. The first is that there are higher rates of subjective depression, hopelessness and serious suicidal thoughts among patients who have attempted suicide. The second key difference is that patients who have attempted suicide show signs like being impulsive and aggressive throughout the course of their lives. Individuals who have attempted suicide are more impulsive in interpersonal relations compared to individuals who have not attempted suicide (47,48). Bipolar disorder patients who have attempted suicide are found to have higher aggression levels compared to patients who have not attempted suicide, while the impulsiveness levels of the two groups are found to be similar (49). In our study, according to BIS-11, attentional impulsiveness, motor impulsiveness and non-planning impulsiveness subgroups were found to be statistically significantly higher in the group with suicide attempts. Bipolar disorder patients who have attempted suicide are found to have a higher risk of attempting suicide and to behave more impulsively.
was found to have higher feelings of being stigmatized and introversion scores, while they had lower scores in inner house relations and attending to social events. It is thought that bipolar disorder patients with suicide attempts have worse impaired social functionality; furthermore, stigmatization in society is higher for those patients and introverted individuals that have a greater tendency to attempt suicide.
Being a cross-sectional study design, having relatively a small sample size and to be applied self-report questionnaires are main limitations of this study. Although we could not establish a causal relation or determine predictors with this study, our findings might be important in terms of determining the clinical features of the patient population that we are dealing with.
CONCLUSION
Suicide attempt in bipolar disorder patients is a behavior,
which significantly affects the individual’s life and functionality. Early diagnosis, evaluating the symptomatology, considering the individual and planning the treatment course are the most important factors in prognosis of the disorder. Determining impulsiveness, previous suicide attempts and personality traits of the bipolar disorder patient is substantial for morbidity and mortality. Our study showed that the suicide attempt rate is significantly higher in bipolar disorder patients. Furthermore, we found that the patient group with suicide attempts tend to have personality disorders and are more impulsive. The functionality parameters of this group were also found to be far more impaired. High scores of NS, HA and ST and low scores of S and C were found in the patient group with suicide attempts, which suggests that these parameters might be associated with suicide attempt. Evaluating the risk of suicide, personality traits, impulsiveness and functionality in each bipolar disorder patient may contribute to the diagnosis and treatment course of these patients.
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