A high lethality suicide attempt in a patient with unrecognized bipolar disorder: A case report

Suicide is a major public health problem, accounting for roughly 1,000,000 annual deaths worldwide, many of which are thought to be a result of bipolar disorders. Furthermore, bipolar disorders show an average of a 10 year period between onset of symptoms and clinical diagnosis. The high risk of suicide in bipolar disorders, combined with the difficulties in establishing the diagnosis, make this disorder particularly dangerous: patients with unrecognized bipolar disorder are four times more likely to complete suicide. A woman with undiagnosed bipolar disorder with a history of one prior attempt made a second attempt by means of ingesting roughly 32 grams of acetaminophen. While acetaminophen is used safely by millions, the compound is frequently the cause of intentional and unintentional acute liver failure, leading to 200 deaths in the United States annually. The combination of the availability and toxicity of acetaminophen and the risks associated with undiagnosed bipolar disorder led to a common and avoidable scenario that nearly resulted in patient mortality.