Reducing the risk of suicide in patients with bipolar disorder: Interventions and safeguards

Bipolar disorder exacts a terrible toll on its sufferers owing to the repeated, severe disruptions in the patients' lives, the discomfort and uncertainties of being on rigorous, ongoing pharmacotherapy regimens, the emotional difficulties inherent in experiencing depression and mania, and the fear of a deteriorating course. Patients with bipolar disorder can become quite hopeless about improving their lot, a state of mind that is related to suicide risk. Indeed, the conservative lifetime suicide rate for bipolar sufferers is 15%, thus making the risk of self-harm a typical part of the therapeutic agenda with this population. Therapists assess the patients' risk for suicide via structured interviews, self-report inventories, and an exploration of their “suicidogenic beliefs.” Treatment counteracts the potential threat of suicide on a number of fronts, including: (a) establishing a collaborative, respectful therapeutic relationship in which the therapist strives to understand the patient's despair and provide accurate empathy; (b) devising antisuicide plans of action, including contracts; (c) teaching a wide range of skills, including rational responding, problem solving, communication, moderating activities to experience an optimal amount of mastery and pleasure, objectively assessing the pros and cons of living and dying, and others; (d) maximizing the patient's social support network, including improving family relationships, interacting more effectively with friends and associates, and joining self-help, advocacy groups; and (e) fighting the stigma of bipolar disorder via the acceptance of limitations, while still striving to live life to the fullest through treatment, an optimistic attitude, with long-range, meaningful goals.