[Suicidal attempts in child and adolescent and bipolar disorders]

Abstract

Background: Child and adolescent psychiatrists are frequently confronted with suicide attempts and comorbid mood disorders. Diagnoses of juvenile bipolar disorders (BD) are rare and controversial and standardized assessment is helpful for a reliable diagnosis. The main objective of this study was to identify the number of juvenile bipolar disorder diagnoses according to DSM-5 criteria in a population of children and adolescents hospitalized for suicide attempts. Secondary objectives were the assessment of a patient's characteristics and the comparison of suicide attempt recurrence during 12 months of follow-up.

Methods: This current practice study consecutively included children and adolescents aged 6 to 18 years and hospitalized for a suicide attempt in a French University Pediatric Hospital over a 4-month period. Patients were assessed at baseline, at 3 months and at 12 months. The standardized assessment was realized by the investigator using semi-structured interview K-SADS-PL (2013) to diagnose juvenile bipolar disorders based on DSM-5 criteria. Clinical diagnoses based on medical charts and according to ICD-10 criteria were also collected at 12-month follow-up. Standardized assessment was completed by the French validated K-SADS-PL (2004) for comorbidities (DSM-IV), dimensional assessment by MADRS-YMRS-ARI-C-SSR, and C-GAS at inclusion. Patients were divided into two groups: (1) those presenting juvenile bipolar disorder according to DSM 5 (BD+) and (2) those without criteria for bipolar disorder (BD-). Suicide risk factors and suicide attempt relapse were assessed at 3 and 12 months of follow-up.

Results: Twenty-six inpatients (22 female and 4 male) aged 14.5 years (SD 1,5) were consecutively included. Twenty patients were followed up during the 12-month period. At baseline, 5 patients (19.2 %) presented a diagnosis of BD (DSM-5): 1 BD type 2, 2 non specified BD, 2 cyclothymic disorders. According to the medical charts (ICD-10), none of the patients had been diagnosed with BD but had diagnoses of dysthymia, of borderline personality disorder and of conduct disorder corresponding to DMDD in 3, 2 and 1 patient respectively. During the 12-month follow-up, 9 patients of the BD- group and none of the BD+ presented recurrence of suicide attempt with 67 % during the first 3 months and 3 patients with multi-relapses. These 3 patients were female adolescents out of care and carrying at least three suicide risk factors. Six patients have been lost to follow-up (1 BD+, 5 BD-). In the BD+ group, 3 patients out of 4 had a persistent diagnosis (DSM-5) of BD at 12 months.

Conclusion: In our adolescent population hospitalized for suicidal attempt, 19,2 % present BD using DSM-5 criteria. Diagnoses are stable during 12 months of follow-up, but under diagnosed in current clinical practice. DSM-5 standardized assessment appears to be very important to diagnose juvenile BD, mandatory for medium and long-term psychiatric follow-up, especially for suicide prevention and psychopharmacologic therapeutics. Nevertheless, no recurrence of suicide attempts has been observed in our BP+ group, contrary to BP-, possibly due the absence of BP 1 disorder.

Keywords: Child and adolescent psychiatry; DSM-5; Enfant et adolescent; Juvenile bipolar disorder; Relapse; Récidive; Suicide attempt; Tentative de suicide; Trouble bipolaire.