Behavior In Depressed Patients Research Articles

The role of moral objections to suicide in the assessment of suicidal patients

Background Moral and religious objections to suicide (MOS) are reported to be associated with less suicidal behavior in depressed patients, and are proposed to act as a protective factor against suicidal behavior. It is unclear whether MOS are a protective factor against suicide attempt per se, or if this effect is mediated through other variables. Method Depressed inpatients ( n = 265) reporting low or high MOS were compared on history of suicidal behaviour, demographic and clinical characteristics. Results Patients with low MOS had significantly more lifetime suicide attempts, were more often without religious affiliation, had greater depression severity, hopelessness and trait impulsivity, less anxiety and fewer reasons for living. Logistic regression revealed that lower MOS was independently associated with suicide attempt. Conclusions Moral and religious objections to suicide may serve as a protective factor against suicidal acts given their unique association with less suicidal behavior in depressed inpatients.

Changes in the mental representations of relational behavior in depressive patients

In this study the mental representations of interpersonal relations in depressive patients were assessed using the axis relationships of the operationalized psychodynamic diagnostics (OPD) system. The data were obtained at the beginning and at the end of inpatient psychotherapy. Although a link was assumed to exist between the severity of the symptoms and the variability of the mental representation of relational behavior, this was not proven. Also, contrary to expectations, an increase in the variability of the mental representations of the patients’ own relational behavior was not observed on completion of therapy. However, patients’ mental representation of their social partners’ relational behavior tends to become more variable. A shift in the focus of relationships was also observed.

Vasopressin–neurophysin and DST in major depression: Relationship with suicidal behavior

The purpose of the present study was to assess if AVP-neurophysin is associated with hypercortisolemia and suicidal behaviour in depressed patients. The study included 28 patients subgrouped into suicide attempters ( n = 13) and nonattempters ( n = 15). We assessed basal AVP-neurophysins concentrations and post-dexamethasone (DST) cortisol levels. Concentrations of AVP-neurophysins did not differ between DST suppressors and nonsuppressors: 0.29 ± 0.13 ng/ml vs 0.36 ± 0.21 ng/ml, ( F = 1.1, df = 1, 27, p = 0.30). Suicide attempters did not differ from nonattempters for AVP-neurophysins levels. Our results fail to support a role of AVP in the early cortisol escape.

Antidepressants and Suicidal Behavior: Cause or Cure?

Antidepressants and Suicidal Behavior: Cause or Cure?

CSF monoamine metabolites and lethality of suicide attempts in depressed patients with alcohol dependence

Background: Alcohol dependence (alcoholism) and major depressive disorder are frequently comorbid and are risk factors for suicidal behavior. Monoaminergic abnormalities have been implicated in the pathophysiology of depression, alcohol dependence, and suicidal behavior. Lower cerebrospinal fluid (CSF) 5-hydroxyindolacetic acid (5-HIAA) levels are associated with higher lethality of suicide attempts in major depression and predict a higher rate of future suicide. We sought to study the relationship of CSF monoamine metabolites to lethality of suicidal acts in depressed subjects with comorbid alcoholism. Methods: We compared 16 high- and 16 low-lethality drug-free depressed suicide attempters with comorbid alcoholism. Subjects were free from any substance use disorder for at least two months. Demographic and clinical parameters, and CSF 5-HIAA, homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels were examined. Results: The two groups did not differ with regard to the demographic characteristics. CSF 5-HIAA levels were lower in high-lethality attempters compared to low-lethality attempters. There were no group difference in CSF HVA or MHPG levels. Conclusion: Higher lethality of suicidal behavior in depressed patients with alcoholism is related to lower serotonergic activity.

Moral Objections to Suicide

Patients with cluster B personality disorder (CBPD) are particularly prone to suicidal behavior, yet possible protective mechanisms are not often studied. The present study investigated a possible protective role of moral objections to suicide (MOS) against suicidal behavior in patients with CBPD and current depression. The effect of MOS was then examined in relation to other mechanisms affecting suicide risk including trait aggressivity and the presence of effective coping strategies. 147 depressed patients with comorbid CBPD (DSM-III-R) were compared with 210 depressed patients without CBPD in terms of their history of suicide attempts and clinical and demographic characteristics. The relationship of MOS to suicide attempt was examined by logistic regression controlling for demographic and clinical differences between the groups as well as presence of comorbid CBPD. Data were collected from 1990 to 2003. Subjects with comorbid CBPD had fewer MOS and reported more previous suicide attempts. In logistic regression, fewer MOS/religious beliefs, lower coping potential, and higher aggression level were associated with suicide attempt. A CBPD diagnosis did not affect the relationship between MOS and suicide attempts. The results of this study suggest that the presence of MOS/religious beliefs may have a protective effect against suicidal behavior in depressed patients with comorbid CBPD and may be a target for therapeutic intervention.

Normal prepulse inhibition and habituation of acoustic startle response in suicidal depressive patients without psychotic symptoms

Background Until now, there is a lack of useful biological markers to predict suicidal behavior in depressive patients. However, it is consistently found that suicidality is associated with a central serotonin deficit. Animal data suggest that prepulse inhibition (PPI) as well as habituation of the acoustic startle response (ASR), which are established as operational measures for sensorimotor gating, decreases after serotonin depletion. Thus, we investigated PPI and habituation of ASR in suicidal patients with depressive disorders as potential biological markers for suicidal behavior. Methods PPI and habituation of ASR was measured in 20 depressive patients who had at least one suicide attempt within the last three month. Eighteen healthy matched controls were examined likewise. Results Suicidal depressive patients did not differ from healthy controls in PPI, startle reactivity and habituation of ASR. Subgroup analyses showed that factors such as severity of depression, impulsiveness, gender, smoking, lethality of the last suicide attempt, number of suicide attempts, and medication had no influence on the results. Conclusions These results suggest that neither PPI nor habituation of ASR could serve as useful markers for suicidality.

Ghrelin – a modulator of depression associated eating disturbances

Aims: Appetite and eating behavior are frequently altered in psychiatric patients suffering from major depression or schizophrenia. However, little is known about the neurobiological mechanisms lying behind this phenomenon. The newly discovered gut-derived neuropeptide ghrelin simulates hunger and weight gain. Therefore, it might be involved in changes of appetite regulation during psychiatric disorders. Methods: In 22 hospitalized patients (20 depressed, 12 schizophrenic) and 24 healthy controls plasma ghrelin levels were measured and the psychometric scores on the Three Factor Eating Questionnaire (TFEQ) were assessed. Results: Neither ghrelin levels, nor TFEQ scores differed between patients suffering from depression or schizophrenia and healthy subjects. In the total group (r=0.455, corr. r²=0.138, F[4, 50]=3.007, p<0.05) and in the subgroup of depressed patients (r=0.682, corr. r²=0.427, F[1, 15]=12.163, p<0.01) TFEQ subscale 2 (disinhibition) was predicted by BMI corrected ghrelin levels, while age, gender, smoking, and medication did not show any influence. Conclusions: Ghrelin seems to be involved in appetite regulating pathways during psychiatric disorders like major depression or schizophrenia. However, its influence is not likely to be displayed as a difference between diagnostic groups. Rather, ghrelin is associated with a trait factor of eating behavior in depressed patients meaning susceptibility to eating problems.

Hypothalamus-pituitary-adrenal system regulation and suicidal behavior in depression

One of the most demanding tasks in psychiatry is to protect patients from suicidal attempts. Preventive strategies could be improved by increasing our knowledge on the pathophysiologic disturbances underlying this behavior. More than 70-80% of suicides occur in the context of depressive disorders, in which dysregulation of the hypothalamus-pituitary-adrenal (HPA) axis is one of the most prominent neurobiological findings. So far data on the involvement of the HPA axis in the pathophysiology of suicidal behavior in depressed patients are controversial. In this retrospective study, we administered the combined dexamethasone-suppression/CRH stimulation (Dex/CRH) test to 310 patients with a depressive syndrome characterized at admission for acute and past suicidal behavior within the first 10 days after hospitalization. Suicidal behavior in depressed patients, including past and recent suicide attempts as well as suicidal ideation, was associated with a lower adrenocorticotropin and cortisol response in the combined Dex/CRH test, with lowest hormone levels observed in patients with a recent suicide attempt. The findings suggest that suicidal behavior may alter HPA axis regulation in depressed patients. Large-scale prospective studies assessing neuroendocrine changes may help to develop predictors for an early identification of patients at risk for committing suicide.

P.2.074 Thyroid axis activity and suicidal behavior in depressed patients

Fluoxetine, a selective serotonin (5-HT) reuptake inhibitor (SSRI), and trazodone, a heterocyclic antidepressant, are effective in the treatment of major depression and treatment resistant depression (TRD). Chronic treatment with both drugs causes increases in extracellular 5-HT through 5-HT reuptake inhibition and desensitization of inhibitory 5-HT1A autoreceptors. It has been shown that pindolol, a serotonin (5-HT)1A-receptor antagonist, may shorten the latency of onset of SSRIs in depression. The aim of the present study was to examine whether pindolol may increase the efficacy of a subtherapeutical dosage of trazodone in the treatment of major depression and TRD, defined according to the Thase and Rush criteria (1995). Thirty-three major depressed inpatients of whom 26 with TRD participated in this study. Ten days after hospitalization, treatment with trazodone 100 mg/day was started. After 1 week trazodone treatment, patients were randomized — using a double blind placebo controlled design — to receive trazodone 100 mg/day + placebo; trazodone 100 mg/day + pindolol 7.5 mg/day; or trazodone 100 mg/day + fluoxetine 20 mg/day and treated during 4 weeks. The 17-item Hamilton Depression Rating Scale (HDRS) was used as outcome measure. It was found that trazodone + pindolol was as effective as trazodone + fluoxetine in the treatment of major depression and TRD and significantly more effective than trazodone + placebo. Using an outcome measure of 50% reduction in the HDRS, we found that 72.5% of the depressed patients treated with trazodone + pindolol and 75% of depressed patients treated with trazodone + fluoxetine showed a clinically significant response compared with 20.0% of trazodone + placebo-treated patients.

The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism

Background Alcoholism and depression are often comorbid. Studies suggest that depressed subjects with alcoholism have more chronic impairment and suicidal behavior than individuals with either diagnosis alone. The reason for higher rate of suicide and suicide attempts in comorbid subjects is uncertain. We explored clinical characteristics that may be associated with this increased suicidality. Methods In all, 219 depressed subjects ( n=62 males and n=157 females) without a history of any alcohol or substance use disorder and 129 ( n=49 males and n=80 females) depressed individuals with a prior history of alcohol use disorder participated in the study. Demographic and clinical parameters were assessed and recorded. Results Depressed subjects with a history of alcoholism had higher lifetime aggression and impulsivity, and were more likely to report a history of childhood abuse, suicide attempts, and tobacco smoking. Depressed suicide ideators with a history of alcoholism had higher suicide ideation scores than depressed suicide ideators without a history of alcoholism. Subjects with a history of alcoholism were younger at the time of the first depressive episode and first hospitalization than those without a history of alcoholism. Logistic regression analysis indicated that alcoholism was significantly associated with smoking and aggression. Suicidal behavior and higher suicidal ideation in depressed subjects with a history of alcoholism might be attributed to higher aggression scores in this group. Conclusion The greater frequency of suicidal behavior and severity of suicidal ideation in major depression with comorbid alcoholism appears related to associated aggressive traits. Alcoholism, aggression, smoking, and suicide may have a common biological causal substrate.

Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients

Little is known about the effects of recurring depressive episodes on cognition and behavior. The objective of the study was to compare cognitive function and depression-related behavior between healthy female subjects and female outpatients with early-onset DSM-IV recurrent major depressive disorder and to investigate the effect of cumulative depressive duration. Neuropsychological tests and scales for apathy, anhedonia and psychomotor retardation were assessed in 23 female patients and 60 healthy age-matched female controls. Significantly higher levels of apathy, anhedonia and psychomotor retardation, and worse performance on tests of executive function were found in the patient group compared with the healthy controls. In the patient group, cumulative depression duration was not significantly correlated with cognitive function, apathy, anhedonia or psychomotor retardation. The deficits in executive function were not related to the actual level of depression. Mild executive dysfunction may be the effect of the illness process underlying recurrent depressive disorder. Repeated or extensive depressive episodes do not seem to additionally affect cognitive deficits or behavior in depressed patients.

Coping behavior in depressed patients: a longitudinal study

The relationship of coping behavior to outcome in depressed patients was examined. Subjects ( n=105) with major depressive disorder ( n=85), depressive disorder not otherwise specified ( n=7) or major depressive disorder with axis I comorbidity ( n=13) were followed for 6 months. Their coping behavior (i.e. rumination, active distraction, cognitive distraction and dangerous activities) was defined using the Comprehensive Assessment List for Affective Disorders. Based on their Hamilton Rating Scale for Depression (HRSD) scores at 6 months, the patients were categorized as having had a good or a poor outcome. Severity of depression and coping behavior were similar among the three diagnostic groups. At baseline assessment, coping behavior was not correlated with either HRSD score or age. However, males were significantly more likely to be engaged in dangerous activity as a coping behavior than females. Patients with a good outcome at 6 months were significantly more likely to use rumination as a coping behavior while patients with a poor outcome were significantly more likely to use dangerous activity. Multiple regression analysis confirmed this finding, indicating that rumination and dangerous activity were significant predictors of outcome at 6 months. Rumination might be associated with good outcomes in depressed patients while dangerous activity might be associated with poor outcomes.

The 5-HT(2A) receptor gene 102T/C polymorphism is associated with suicidal behavior in depressed patients.

Several lines of evidence suggest that genetic factors constitute an important determinant of suicidal behavior. A significant association between the 5-HT(2A)-C allele and suicidality has recently been reported. The aim of this study was to investigate whether the proposed association between 5-HT(2A)-102T/C polymorphism and suicidality could be replicated in a larger and independent sample of Spanish patients with major depression. The 102T/C polymorphism of the 5-HT(2A) receptor gene was analyzed in 159 patients with major depression (DSM-IV criteria) and 164 unrelated and healthy controls using a case control design. All individuals were subjects of Spanish origin. Significant differences in allele (chi-square = 4.13, df = 1, P = 0.04) and genotype (chi-square = 6.19, df = 2, P = 0.04) distributions were found between non-suicide attempters and suicide attempters. Moreover, those patients carrying 5-HT(2A)-C allele had more than five times the risk for attempting suicide than noncarriers (OR = 5.50, 95% CI = 1.18-35.20, P = 0.01). Our results replicate the proposed association between 5HT(2A)-C allele and suicidality in major depression. Moreover, no overall associations are detected when patients with major depression and controls are compared for 102T/C frequencies, suggesting that the increased risk for suicidality conferred by 5-HT(2A)-C allele is primarily associated with suicidal behavior and not with the diagnosis of major depression itself.

Prolactin response to d-fenfluramine and suicidal behavior in depressed patients

Previous studies of the prolactin response to d-fenfluramine in depressed patients have yielded inconsistent results. This may be because they did not address the question of suicidality. We carried out this study to test the hypothesis that lower prolactin response to d-fenfluramine is more closely associated with suicidal behavior than with depression itself. A d-fenfluramine test was performed in a sample of 18 healthy control subjects and in 85 drug-free inpatients with a DSM-III-R diagnosis of major depressive episode (49 with a history of suicide attempt, 36 without). Depressed inpatients with a history of suicide attempt showed a significantly lower prolactin response to d-fenfluramine compared to depressed inpatients without such a history and compared to control subjects. Healthy control subjects and depressed inpatients without a history of suicide attempt showed comparable levels of prolactin after d-fenfluramine. Time elapsed since suicide attempt did not influence prolactin level (baseline or post-stimulation). Results show that in our depressed drug-free inpatient sample, prolactin response to d-fenfluramine seems to be a marker of suicidality, but not of depression itself. We suggest that it is a trait marker of suicidality.

Suicidal Behavior in Depression: Relationship to Platelet Serotonin Transporter

Objective: Suicidal behavior in depressed patients is associated with low central serotonin. Thus, platelet serotonin uptake in relation to suicidal behavior in depression was examined. Methods: Depressed patients who had never attempted suicide (n = 23) were compared with depressed patients who had never attempted suicide (n = 26) and normal controls (n = 71) for platelet serotonin uptake. Results: Depressed patients who had a lifetime history of a suicide attempt had a significantly greater apparent Michaelis constant (K_m) of platelet serotonin uptake than either depressed patients who had never attempted suicide or controls. Patients rated high for current suicidal ideation at the index admission had significantly higher K_m values than patients rated low. Also, patients who reattempted or committed suicide during a 5-year follow-up period had significantly higher K_m values than controls. Among women patients who had attempted suicide there was a significant correlation between extrapunitive hostility scores and K_m values. Conclusion: The serotonin transporter warrants further study in relation to suicidal behavior in depression.

Comparison of buying behavior in depressed patients presenting with or without compulsive buying

Compulsive buying is defined as repetitive impulsive and excessive buying leading to personal and familial distress. This study compares the buying behavior of depressed patients presenting with or without compulsive buying. The weight of promotional factors such as sales and advertising campaigns was systematically assessed. The impulsive nature of compulsive buying and the choice of items purchased were also investigated. For this purpose, we studied buying behavior among 52 inpatients diagnosed for major depressive episode with DSM-IV criteria. None of the patients presented mania or hypomania, obsessive-compulsive disorder, or alcohol or drug abuse or dependence disorder. We assessed the prevalence of compulsive buying and compared the “buying style” among patients with (CB +) and without (CB −) compulsive byying. The diagnosis of depression was assessed with the Mini International Neuropsychiatric Interview (MINI). The diagnosis of compulsive buying was made using standardized criteria and a specific rating scale. All patients answered a specific questionnaire assessing the phenomenology of the buying behavior. Twenty-one of 52 depressives presented with compulsive buying. The CB+ group was not more sensitive to promotional factors. They did not seek sales or use loans significantly more than others. Upon entering a shop, the CB + subjects did not change their choice more often than others. CB + subjects were significantly more often alone while shopping (85% of cases v61% of CB − group, p = .05). Most purchases from the CB + group were self-gifts or gifts to others (50.4% v 23.5%, p = .003); 14.4% of purchases in the CB + group ( v 2.2% in CB − group, P = .045) were made because the patients believed their social status requires acquisition. Items to be bought were more often considered by CB + subjects as occasions not to be missed (31.4% v 15.1%, P = .03). Purchases were significantly (57% v 16%) less often used than expected by the CB + group ( P = .002). Most purchases, in addition, represented gifts for oneself or others and were used significantly less often than expected.

Possible association of a polymorphism of the tryptophan hydroxylase gene with suicidal behavior in depressed patients.

This study was designed to test the hypothesis that serotonin-system-related genes may be correlated with suicide risk. Fifty-one unrelated Caucasian inpatients with major depression, with or without a history of suicidal acts, were genotyped for a biallelic polymorphism at the tryptophan hydroxylase locus. The less common tryptophan hydroxylase U allele occurred with greater frequency in the patients who had attempted suicide. A logistic regression analysis confirmed an association between tryptophan hydroxylase genotype and lifetime history of suicide attempts. Serotonergic-system-related genes may influence the risk of suicide in persons with major depression.

Relationship between alpha 2-adrenergic function and suicidal behavior in depressed patients

The current main neurochemical theories of the biological correlates of suicidal behavior involve serotonergic and, to a lesser extent, dopaminergic systems. Few data are available about the possible implication of the noradrenergic function. In the present study, we assessed the growth hormone response to clonidine, a selective α 2-adrenergic agonist, in 15 DSM-III-R major depressive inpatients with a history of suicide attempts, compared with 15 age- and gender-matched major depressive inpatients without a history of suicidal behavior. Mean (± SD) growth hormone peak responses to clonidine were significantly lower in the group of suicide attempters than in the control group: 2.93 ± 3.01 ng/ml vs. 8.28 ± 8.15 ng/ml. Therefore, these results suggest that a blunted growth hormone response to clonidine could be a biological correlate of suicidal behavior.

Can future suicidal behaviour in depressed patients be predicted?

The determinants of suicidal behaviour over 18 years were examined in a series of 89 depressed in-patients, using index data on clinical features, personality, and history of past loss. Seven variables were selected from univariate analyses and their relationship with (1) the presence or absence, (2) frequency, (3) intent, and (4) medical threat of suicidal behaviour was then explored by generalised linear modelling. Severe dysphoria, past alcoholism and chronic physical illness were most predictive of suicidal attempting; however, different variables predicted the frequency, degree of intent and severity of medical threat of subsequent suicidal attempts. Thus, our results suggest that different aspects of long-term suicidal behaviour have different determinants.