Amanda Galvão-de Almeida(1,2), Fabiana Nery-Fernandes(1), Ilza Rosa Batista(2), Camila Guindalini(2), Esdras Cabus Moreira(1) and Ângela Miranda-Scippa(1)
(1) Universidade Federal da Bahia, Bahia, Brazil; (2) Universidade Federal de São Paulo, São Paulo, Brazil
Suicidal Behavior in Alcohol and Drug Abuse and Dependence. Hauppauge, New York: Nova Science Publishers, 2010, 540 pages.

Background

Bipolar disorder is a frequent and chronic affective illness associated with significant global dysfunction and suicidal behavior. Bipolar patients frequently have other Axis I psychiatric disorders such as substance abuse or dependence affecting up to 60% of these individuals. Substance use disorders can independently lead to risk-taking behaviors and suicidality. Therefore, we gathered data about bipolar disorder and substance use disorders as single and as combined factors leading to suicidal behavior. We also discussed some neurobiological findings related to this comorbidity.

Methods

We reviewed the Medline database in search for studies published in English, Spanish or Portuguese until June 1st 2009, containing the following keywords: “bipolar disorder”, “suicidal behavior”, “suicide”, “substance use disorders”, “alcohol”, “drugs”, “cocaine”, “cannabis”, “marijuana”, “opiate”, “amphetamine”, “comorbidity”.

Results

Comorbididy with substance use disorders, especially alcohol abuse and dependence, impose higher rates of suicidal behavior on bipolar patients. The presence of the comorbidity seems to be significantly more associated with suicidality than either bipolar or alcohol/drug use disorder. Some factors seem to mediate the frequency and severity of suicidal behavior in bipolar patients with substance use disorders: early onset of bipolar disorder, drug abuse after the onset of affective illness, aggressive and/or hostile behavior, impulsivity, and frequency of mixed depression.

Conclusion

Assessment of suicidal thoughts and past history of suicide attempts is especially important in patients with comorbid bipolar and substance use disorders in order to adequately treat these individuals and reduce the frequency and consequences of suicidal behavior.