Affective Temperaments and Clinical Course of Bipolar Disorder: An Exploratory Study of Differences among Patients with and without a History of Violent Suicide Attempts

Abstract: Background and Objectives: Suicide is the leading cause of death in patients with Bipolar Disorder (BD). In particular, the high mortality rate is due to violent suicide attempts. Several risk factors associated with suicide attempts in patients with BD have been identified. Affective temperamentsareassociatedwithsuicidalrisk,buttheirpredictiveroleisstillunderstudied. Theaim of this study is to assess the relationship between affective temperaments and personal history of violent suicide attempts. Materials and Methods: 74 patients with Bipolar Disorder type I (BD-I) or II (BD-II) were included. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (short TEMPS-M) and the Temperament and Character Inventory,revisedversion(TCI-R).Thesamplewasdividedintotwogroupsonthebasisofapositive historyforsuicidalattemptsandthesuicidalgroupwasfurtherdividedintotwosubgroupsaccording to violent suicide attempts. Results: Violent suicide attempts were positively associated with the cyclothymic temperament and inversely to the hyperthymic one. BD-I patients and patients with a clinical history of rapid cycling were significantly more represented in the group of patients with a history of violent suicide attempts. Conclusions: Our study highlights that several clinical and temperamentalcharacteristicsareassociatedwithviolentsuicideattempts,suggestingtheimportance of affective temperaments in the clinical management of patients with BPI.