The article you requested is
Integration of Suicide Prevention Into Outpatient Management of Bipolar Disorder
J Clin Psychiatry 2001;62(suppl 25):3-11
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Suicide prevention is a critical objective in the treatment of bipolar disorder. This article describes
practical mechanisms by which monitoring and management of suicide risk can be integrated into the
routine care of patients with bipolar disorder. Suicide risk is assessed in terms of inclination (the drive
to commit a self-destructive act) and opportunity (access to lethal means). Intervention strategies are
adapted to the needs of bipolar patients across 3 phases of treatment: the acute episode; the continuation
phase, when symptom reduction has occurred but adaptive recovery has not; and the maintenance
phase, in which optimization of adaptive function and vigilance against impending relapse are paramount.
Integration of suicide prevention into the outpatient management plan begins with a routine
discussion of suicide risk at the initiation of a treatment relationship, even in the absence of other
known risk factors. This discussion paves the way for ongoing assessment of suicidality. Just as the
recommended routine monitoring of every euthymic bipolar patient includes at least some minimal
assessment for prodromal symptoms of acute mania or depression, every clinical visit can include
sufficient probes to determine the need for new interventions specific to suicide prevention. Ongoing
assessment of risk and protective factors can be linked to a range of individualized interventions
designed to meet the varying needs of patients over time. The intensity of monitoring and interventions
reflects the clinician’s knowledge of risk factors and may be life saving, but it is also important
that patients and others involved in their care understand that monitoring cannot guarantee safety.