Year: 2003
Type: letter
Abstract: Agitation and Inpatient SuicideSir: I read with interest the excellent article by Busch and colleagues 1 describing the clinical correlates of suicide among hospitalized patients.It is argued that the presence of severe anxiety and agitation symptoms may be an important but treatable acute predictor of suicide.While aggressive pharmacologic treatment of suicide-related target symptoms is advisable, it is important to determine the context and pattern of evolution of such symptoms in the course of psychiatric illness, particularly mood disorders.The results of this study 1 demonstrated evidence of significant psychic anxiety or agitation in nearly 80% of patients during the week prior to suicide, but only 8% (N = 6 of 76) of the cases were diagnosed with agitated depression at admission.It is not clear whether symptoms of psychic anxiety and agitation were present in variable degrees during the entire index hospitalization or a change in psychomotor activity occurred proximally to the time of suicide.Another issue that needs clarification is the source of these symptoms that can occur in relation to symptomatic or syndromal comorbidity with anxiety.The use of antidepressants in patients with a bipolar diathesis can lead to the development of agitation and insomnia against the backdrop of atypical symptoms such as psychomotor retardation and hypersomnia.Finally, mixed episodes that are associated with a high risk of suicide are often accompanied by symptoms including anxiety and agitation.Contrary to the results of studies showing that the diagnosis of bipolar disorder, particularly bipolar II disorder, is associated with an elevated risk of suicide, the number of individuals with bipolar disorder in this study was surprisingly low.2,3 The rapidly fluctuating clinical course and the presence of symptoms including mood lability and psychosis in some patients raises the possibility of a higher than reported prevalence of bipolarity, particularly mixed episodes.As antidepressants can cause mood instability in some patients, it is important to study the relationship between changes in the clinical state, especially cognition, mood, psychomotor activity and sleep, and the use of these drugs.If case-controlled studies confirm such an association, caution may be needed regarding the use of antidepressants in at least some patients at acute risk for suicide.
Authors: Jan Fawcett, Katie A Busch, Douglas G. Jacobs
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W1967628222