232 CHAPTER 6
Suicidal ideation
Thoughts of suicide.- Social factors that are associated with bipolar disorders in-
clude disruptive life changes and social and environmental
stressors. The different factors create feedback loops that
can lead to a bipolar disorder or make the patient more likely
to relapse. - Treatments that target neurological factors include lithium
and anticonvulsants, which act as mood stabilizers. When
manic, patients may receive an antipsychotic medication or a
benzodiazepine. Patients with a bipolar disorder who have
MDEs may receive an antidepressant along with a mood
stabilizer. - Treatment that targets psychological factors—particularly
CBT—helps patients recognize warning signs of mood episodes,
develop better sleeping strategies, and, when appropriate, stay
on medication. - Treatments that target social factors include:
- interpersonal and social rhythm therapy (IPSRT), which
can increase the regularity of daily events and decrease
social stressors;- family therapy, which is designed to educate family mem-
bers about bipolar disorder, improve positive communica-
tion, and decrease criticism by family members; and - group therapy or a self-help group, which is intended to
decrease shame and isolation.
- family therapy, which is designed to educate family mem-
- interpersonal and social rhythm therapy (IPSRT), which
Making a Diagnosis
- Reread Case 6.4 about the person with fl ight of ideas, and de-
termine whether or not the man’s symptoms meet the criteria
for a bipolar disorder, and if so, which type of bipolar disorder.
Specifi cally, list which criteria apply and which do not. If you
would like more information to determine his diagnosis, what
information—specifi cally—would you want, and in what ways
would the information infl uence your decision? - Reread Case 6.5 about Mr. F., and determine whether or not
his symptoms meet the criteria for cyclothymic disorder.
Specifi cally, list which criteria apply and which do not. If you
would like more information to determine his diagnosis, what
information—specifi cally—would you want, and in what ways
would the information infl uence your decision?
Suicide
On more than one occasion, Kay Jamison seriously contemplated suicide. One day,
when deeply depressed, she did more than think about it—she attempted suicide.
Here she describes her motivation:
I could not stand the pain any longer, could not abide the bone-weary and tiresome per-
son I had become, and felt that I could not continue to be responsible for the turmoil
I was infl icting upon my friends and family. In a perverse linking with my mind I thought
that... I was doing the only fair thing for the people I cared about; it was also the only
sensible thing to do for myself. One would put an animal to death for far less suffering.
(Jamison, 1995, p. 115)
When Jamison attempted suicide, she was already receiving treatment for her disor-
der; in contrast, a majority of people who die by suicide have an untreated mental
disorder, most commonly depression. Fortunately, Jamison’s attempt was foiled. She
later describes being grateful that she continued living. The hopelessness that
she had felt went away, and she was able to enjoy life again.Suicidal Thoughts and Suicide Risks
In the United States and Canada, suicide is ranked 11th among causes of death
(McIntosh, 2003; Statistics Canada, 2005). Approximately 32,000 people die
by suicide each year in the United States (Centers for Disease Control and
Prevention [CDC], 2005), which constitutes about 1% of all deaths per year
(McIntosh, 2003). Worldwide, suicide is the second most frequent cause of
death among women under 45 years old (tuberculosis ranks fi rst), and it is the
fourth most frequent cause among men under 45 (after road accidents, tuber-
culosis, and violence; WHO, 1999). Table 6.11 lists more facts about suicide.Thinking About, Planning, and Attempting Suicide
When suffering from a mood disorder, people may have thoughts of death or thoughts
about committing suicide, known as suicidal ideation (Rihmer, 2007). But suicidal
ideation does not necessarily indicate the presence of a psychological disorder or an
actual suicide risk. Approximately 10–18% of the general population—includingPast research suggested that suicide rates peak in
the spring for both men and women, with another
peak in the autumn for women (Barraclough &
White, 1978a, 1978b; Meares et al., 1981). However,
more recent research suggests that such a rela-
tionship may be weakening over time (Hakko,
Räsänen, & Tiihonen, 1998; Jessen, Steffensen, &
Jensen, 1998; Parker et al., 2001; Rihmer et al.,
1998; Yip, Callahan, & Yuen, 2000; Yip, Chao, &
Ho, 1998; Yip, Yang, & Qin, 2006), perhaps be-
cause the effects of seasonal differences are
minimized by modern artifi cial environments
(Simkins et al., 2003).Craig Tuttle/Corbis