Schema modes after remission and past suicide attempts in bipolar disorder
- Researchers at Asan Medical Center in Seoul studied 231 outpatients in full remission from major depressive disorder (n = 118) or bipolar disorders (n = 113); 68.0% were women, mean age was 33.5 years, and none had a diagnosed personality disorder.
- Latent profile analysis of the 14 Schema Mode Inventory subscales identified three profiles: Adaptive (31.6%), Mixed (44.2%) and Highly Maladaptive (24.2%).
- The Mixed profile combined elevated adaptive and maladaptive schema modes, while the Highly Maladaptive profile showed pervasive elevations in dysfunctional modes.
- Profile and diagnosis interacted (p = .014), with age and sex controlled. In remitted bipolar disorder, the Highly Maladaptive profile was associated with significantly more lifetime suicide attempts than the Mixed profile; in remitted major depression, the profiles did not differ.
Full remission is usually where the treatment record goes quiet. The scales are low and the episode is over. A team at Asan Medical Center in Seoul looked at what stays in place after that point, in the pattern of schema modes, and set it against each patient's history of suicide attempts.
Three profiles among 231 remitted outpatients
The sample was 118 people with major depressive disorder and 113 with bipolar disorders, all in full remission. Sixty-eight percent were women, the mean age was 33.5, and nobody carried a personality disorder diagnosis. Everyone completed the Schema Mode Inventory. Latent profile analysis then sorted patients by the overall shape of their 14 subscale scores, not by any single scale.
Three groups came out. Adaptive covered 31.6% of the sample, Mixed 44.2%, Highly Maladaptive 24.2%. Mixed is not a midpoint: adaptive and maladaptive modes were both elevated at once. In the Highly Maladaptive group, dysfunctional modes were high across the board.
The outcome was the number of lifetime suicide attempts, compared by profile and diagnosis with adjustment for age and sex. The interaction was significant (p = .014). Among bipolar patients, the Highly Maladaptive profile went with more attempts than the Mixed profile. Among patients with depression, profiles made no difference. The authors propose schema mode profiling during remission as part of suicide risk assessment, and see schema therapy that strengthens adaptive modes and weakens maladaptive ones as a possible route to prevention, particularly in bipolar disorder.
Where the safety plan stays open
I read this as a case against closing the file at remission. A depression scale measures the episode. It says little about the modes a person returns to under pressure, and in this sample a quarter of remitted patients still had dysfunctional modes elevated across the board.
For a stabilised bipolar patient, I would add a mode assessment to the relapse plan – the SMI or a structured conversation about modes. Read the result next to the attempt history. If dysfunctional modes are high and adaptive ones low, keep the safety plan open after the episode ends.
In remitted bipolar disorder, a profile of pervasively elevated dysfunctional schema modes went with more past suicide attempts, even though mood symptoms were in remission.
This note is based on the published abstract; the full text was not available, so the number of attempts per profile and effect sizes are not reported here. Suicide attempts were counted over the lifetime, and the sample consisted of Korean outpatients without diagnosed personality disorders.