Monoamine metabolites in CSF and suicidal behavior.
01 Jun 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 6, pp 631-636
TL;DR: A follow-up study revealed a 20% mortality by suicide within a year after lumbar puncture in patients with a CSF-HIAA level below the median, which was lower than normal in suicidal patients who were not diagnosed as depressed at the time of lumbr puncture.
Abstract: • Cerebrospinal fluid concentrations of the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenyl glycol (MHPG) were measured in 30 psychiatric patients who had attempted suicide and 45 healthy volunteers. The suicide attempters had a significantly lower CSF 5-HIAA level than the controls, especially those who had made more violent attempts. After adjustment for differences in body height and age between controls and patients, the difference in 5-HIAA level became even more marked. Concentrations of 5-HIAA also were lower than normal in suicidal patients who were not diagnosed as depressed at the time of lumbar puncture, while HVA levels were lowered only in the depressives. A follow-up study of these and 89 more patients (depressed and/or suicidal) revealed a 20% mortality by suicide within a year after lumbar puncture in patients with a CSF 5-HIAA level below the median.
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TL;DR: A meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome suggests the need for a shift in focus from risk factors to machine learning-based risk algorithms.
Abstract: Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record
2,013 citations
TL;DR: A proposed stress–diathesis model is described in clinical and neurobiological terms, and correlates of the diathesis for suicidal acts point to the involvement of the serotonergic and noradrenergic systems, and the ventromedial prefrontal cortex.
Abstract: About one million suicides and ten million suicide attempts occur worldwide each year. Suicide is not simply a response to stress, but generally a complication of a psychiatric disorder. A proposed stress–diathesis model is described in clinical and neurobiological terms. Neurobiological correlates of the diathesis for suicidal acts point to the involvement of the serotonergic and noradrenergic systems, and the ventromedial prefrontal cortex. Some treatments seem to reduce suicide risk independently of an effect on the primary psychiatric disorder, perhaps by reducing the diathesis.
1,063 citations
TL;DR: The life history of aggression and history of suicidal behavior in 12 subjects with borderline personality disorders without major affective disorder were examined, and Histories of aggressive behaviors and of suicide attempts were significantly associated with each other.
Abstract: In an earlier, separate study, the authors found that human aggression and suicide (a specific aggression-related behavior) were associated with lower levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), a serotonin metabolite. That study focused on subjects with personality disorders without affective illness. In the present study they examine the life history of aggression and history of suicidal behavior in 12 subjects with borderline personality disorders without major affective disorder. Histories of aggressive behaviors and of suicide attempts were significantly associated with each other, and each was significantly associated with lower 5-HIAA levels. Altered serotonin metabolism may be a highly significant contributing factor to these behaviors in whatever diagnostic group they occur. Language: en
926 citations
TL;DR: In this article, the authors integrate the proximate, developmental models with the ultimate, evolutionary ones, suggesting that two developmentally different etiologies of sociopathy emerge from two different evolutionary mechanisms.
Abstract: Sociopaths are “outstanding” members of society in two senses: politically, they draw our attention because of the inordinate amount of crime they commit, and psychologically, they hold our fascination because most ofus cannot fathom the cold, detached way they repeatedly harm and manipulate others. Proximate explanations from behavior genetics, child development, personality theory, learning theory, and social psychology describe a complex interaction of genetic and physiological risk factors with demographic and micro environmental variables that predispose a portion of the population to chronic antisocial behavior. More recent, evolutionary and game theoretic models have tried to present an ultimate explanation of sociopathy as the expression of a frequency-dependent life strategy which is selected, in dynamic equilibrium, in response to certain varying environmental circumstances. This paper tries to integrate the proximate, developmental models with the ultimate, evolutionary ones, suggesting that two developmentally different etiologies of sociopathy emerge from two different evolutionary mechanisms. Social strategies for minimizing the incidence of sociopathic behavior in modern society should consider the two different etiologies and the factors that contribute to them.
855 citations
TL;DR: Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment, and none of them had ever experienced a similar state during treatment with any other psychotropic drug.
Abstract: Six depressed patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after 2-7 weeks of fluoxetine treatment. This state persisted for as little as 3 days to as long as 3 months after discontinuation of fluoxetine. None of these patients had ever experienced a similar state during treatment with any other psychotropic drug.
522 citations
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TL;DR: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described, and its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change.
Abstract: The construction of a depression rating scale designed to be particularly sensitive to treatment effects is described. Ratings of 54 English and 52 Swedish patients on a 65 item comprehensive psychopathology scale were used to identify the 17 most commonly occurring symptoms in primary depressive illness in the combined sample. Ratings on these 17 items for 64 patients participating in studies of four different antidepressant drugs were used to create a depression scale consisting of the 10 items which showed the largest changes with treatment and the highest correlation to overall change. The inner-rater reliability of the new depression scale was high. Scores on the scale correlated significantly with scores on a standard rating scale for depression, the Hamilton Rating Scale (HRS), indicating its validity as a general severity estimate. Its capacity to differentiate between responders and non-responders to antidepressant treatment was better than the HRS, indicating greater sensitivity to change. The practical and ethical implications in terms of smaller sample sizes in clinical trials are discussed.
11,923 citations
TL;DR: Patients in the low 5-HIAA mode (below 15 ng/ml) attempted suicide significantly more often than those in the high mode, and they used more violent means.
Abstract: • The incidence of suicidal acts was studied in 68 depressed patients and related to the level of 5-hydroxyindoleacetic acid (5HIAA) in the cerebrospinal fluid. The distribution of 5-HIAA levels was bimodal. Patients in the low 5-HIAA mode (below 15 ng/ml) attempted suicide significantly more often than those in the high mode, and they used more violent means. Two of the 20 patients in the low mode, and none of the 48 patients in the high mode died from suicide.
1,410 citations
TL;DR: An interdisciplinary group of 15 psychiatrists, psychologists and clinical pharmacologists was formed under the auspices of the Swedish Medical Research Council to study the problem of evaluating change in psychiatric disorders with treatment and decided to construct a new scale covering psychopathological variables likely to be changed by treatment.
Abstract: Very few rating scales have been constructed explicitly for the measurement of change in psychopathology despite the large number of scales available for the assessment of psychiatric illness. The introduction of new intervention techniques in psychiatry has created a need for instruments to evaluate and compare the efficacy of various treatments. Scales that were initially constructed for diagnostic and classificatory purposes have therefore been used to assess treatment effects although it is sometimes doubtful whether they are sensitive enough for that purpose. In 1971, an interdisciplinary group of 15 psychiatrists, psychologists and clinical pharmacologists was formed under the auspices of the Swedish Medical Research Council to study the problem of evaluating change in psychiatric disorders with treatment. An attempt was made to reach agreement on the standardization of measuring techniques. Inquiries were made to all psychiatric university departments in Scandinavia and to the companies producing psychotropic drugs. These revealed a large number of widely differing and overlapping rating scales in current use. None of the scales examined met the requirements of the group and it was felt that no single scale in use could be elaborated or refined sufficiently to adequately measure change over the range of psychiatric syndromes. It was therefore decided to construct a new scale covering psychopathological variables likely to be changed by treatment. Such a scale should be capable of being used either in full, to cover the range of psychopathology or used as a pool of items from which subscales could be drawn for particular psychiatric syndromes.
1,262 citations
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