Suicidal intentionality, attempts and cyclothymic temperament

Depression is a frequent pathology that especially exposes to the suicidal risk. Lately, researches demonstrated that bipolar depression in the setting of a major bipolar disorder is more purveyor of such a risk. A depressive episode that appears in a cyclothymic temperament is considered as a bipolar II ½. In this form of soft bipolarity, suicidal risk appeared much higher than in classical bipolar-II disorder (Akiskal et al, 2003, data from Epidep study). Also in cyclothymic OCD, the suicide risk is doubled when compared to OCD without cyclothymia (Hantouche et al, 2003, from the national ABC-OCD French study). Other recent reports suggested that significant link exist between cyclothymia and suicidality (Rihmer et al, 2005). In order to elaborate more on this observation a Tunisian controlled study had been conducted in the Sfax University A sample of 51 suicidal attempters was compared with 51 healthy controls. The average age was of 23,1 years ( ± 6 years); 66% were female, and 72% were unmarried.

The instruments used

• Scale of suicidal intentionally of Beck

• Montgomery and Asberg Depression Rating Scale (MADRS)

• Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A) in its Arab version.

• Socio-demographic data and circumstances of the suicide attempt.

Results:

• 54% of suicide attempters have been depressed, according to MADRS.

• 64% of them have a cyclothymic temperament. (score > 10)

• Depressed suicide attempters have higher cyclothymic temperament score's than those non depressed

• Suicidal intentionality was more important when depressed attempters have a cyclothymic temperament.

These finding suggest and confirm that depression expose more to the suicidal risk when it occurs in patients with cyclothymic temperament.