Compliance
...Bipolar disorder is a long-term illness in which adherence to carefully designed treatment plans can improve the patient’s health status. However, patients with this disorder are frequently ambivalent about treatment. This ambivalence often takes the form of noncompliance with medication and other treatments, which is a major cause of relapse.
Ambivalence about treatment stems from many factors, one of which is lack of insight. Patients who do not believe that they have a serious illness are not likely to be willing to adhere to long-term treatment regimens. Patients with bipolar disorder may minimize or deny the reality of a prior episode or their own behavior and its consequences. Lack of insight may be especially pronounced during a manic episode...
Suicide
...Like those suffering from major depression, patients with bipolar disorder are at high risk for suicide. The frequency of suicide attempts appears similar for the bipolar I and bipolar II subtypes. Individuals with bipolar disorder repeatedly have been shown to have greater overall mortality than the general population. Although much of this risk reflects the higher rate of suicide, cardiovascular and pulmonary mortality among patients with untreated bipolar disorder is also high.
Known general risk factors for suicide also apply to patients with bipolar disorder. These include a history of suicide attempts, suicidal ideation, comorbid substance abuse, comorbid personality disorders, agitation, pervasive insomnia, impulsiveness, and family history of suicide. Among the phases of bipolar disorder, depression is associated with the highest suicide risk, followed by mixed states and presence of psychotic symptoms, with episodes of mania being least associated with suicide. Suicidal ideation during mixed states has been correlated with the severity of depressive symptoms. In general, a detailed evaluation of the individual patient is necessary to assess suicidal risk. Judgment of suicidal risk is inherently imperfect; therefore, risks and benefits of intervention should be carefully weighed and documented...
Statistically
...Suicide rates are high among bipolar disorder patients. Completed suicide occurs in an estimated 10%– 15% of individuals with bipolar I disorder. Suicide is more likely to occur during a depressive or a mixed episode. Pharmacotherapy may substantially reduce the risk of suicide...
Robert M.A. Hirschfeld, M.D.
Charles L. Bowden, M.D.
Michael J. Gitlin, M.D.
Paul E. Keck, M.D.
Roy H. Perlis, M.D.
Trisha Suppes, M.D., Ph.D.
Michael E. Thase, M.D.
Karen D. Wagner, M.D., Ph.D.
John S. McIntyre, M.D.
Sara C. Charles, M.D.
Kenneth Altshuler, M.D.
Ian Cook, M.D.
C. Deborah Cross, M.D.
Barry J. Landau, M.D.
Louis Alan Moench, M.D.
Stuart W. Twemlow, M.D.
Sherwyn Woods, M.D., Ph.D.
Joel Yager, M.D.
Paula Clayton, M.D.
Marcia Goin, M.D., Ph.D.
Marion Goldstein, M.D.
Sheila Hafter Gray, M.D.
Andrew J. Kolodny, M.D.
Margaret T. Lin, M.D.
Grayson Norquist, M.D.
Susan Stabinsky, M.D.
Robert Johnston, M.D.
James Nininger, M.D.
Roger Peele, M.D.
Daniel Anzia, M.D.
R. Scott Benson, M.D.
Lawrence Lurie, M.D.
R. Dale Walker, M.D.
Rebecca M. Thaler, M.P.H., C.H.E.S.
Robert Kunkle, M.A.
Althea Simpson
Laura J. Fochtmann, M.D.
Claudia Hart, Director, Department of Quality Improvement and Psychiatric Services
Lloyd I. Sederer, M.D., Director, Division of Clinical Services