Suicidal Behavior In Depression Research Articles

Clinical features of the combination of agoraphobia and non-psychotic mental disorders

The review article gives a modern definition of the concept of agoraphobia. Different classification approaches in the typing of agoraphobia are presented. Its role as a factor aggravating the course of non-psychotic mental disorders is shown. The features of its manifestation depending on the nosological affiliation are analyzed. It was revealed that agoraphobia is a predictor of an unfavorable outcome in people with panic disorder. In turn, panic disorder often causes the development of agoraphobia. At the same time, gender and age aspects are noted. The comorbidity of agoraphobia and somato-vegetative type of generalized anxiety disorder is shown. Agoraphobia increases the risk of suicidal behavior in depression, has a high correlation with the severity of personality disorders, especially of the avoidant and dependent type. At the same time, some researchers dispute the point of view that these types of personality disorders are predisposing factors for panic disorder and agoraphobia, based on retrospective data on the premorbid personality structure of patients with anxiety disorders. The relationship between PTSD and panic disorder is emphasized in connection with the emergence of a circular model of the development of feelings of fear, which postulates a similar etiology of anxiety disorders. There is a comorbidity of agoraphobia with disorders of the hypochondriac spectrum: from the degree of fixation to obsessive nature. reduces the effectiveness of therapy for schizophrenic spectrum disorders and the quality of life of patients. The picture of the panic disorder itself with agoraphobia becomes heavier if the patient has chronic alcoholism (in particular, the frequency of seizures increases), while the presence of agoraphobic symptoms leads to a relapse of alcoholic illness, which is explained by taking alcohol to relieve symptoms, and also increases the likelihood of developing dependence on tranquilizers.

Риск суицидального поведения при депрессии в структуре биполярного аффективного расстройства, осложненного зависимостью от растительных каннабиноидов

Introduction. According to clinical observations, depressive states in the structure of bipolar disorder (BD) are observed in 23.8% of the examined patients. Most studies show that compared with the general population, the standardized mortality rate in patients is about 30%; BD patients account for 1.4% of total deaths. Aim. To assess the risk of suicidal behavior in depression in the structure of BD complicated by plant cannabinoid ad¬diction. Materials and methods. For this research, 58 patients with diagnosed BD associated with the syndrome of cannabinoid addiction were selected – the main group (mean age 34 ± 4 years). The control group consisted of 100 individuals with BD without associated pathology (mean age 32 ± 3 years). The duration of the disease in both groups ranged from 1 to 5 years. The following methods and scales were used in the study: clinical method – mental status assessment, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the SAD PERSONS Scale – a scale for suicide risk assessment. Results. The study showed that the risk of suicidal behavior in depression in the structure of BD complicated by plant cannabinoid addiction increases significantly, which is confirmed by the results of assessment using psychometric scales (after 6 months since the beginning of the study in the main group, a high risk of suicide was diagnosed in 8% of cases, after 12 months – in 11%, very high risk – in 4% of cases). The deterioration of the mental state was confirmed by the frequency and longer duration of hospitalizations in a psychiatric hospital: in the main group, the average duration of hospitalization in a psychiatric hospital after 6 months since the beginning of the study was about 5.3 ± 2 months (67% (p < 0.005)), after 12 months – about 5.9 ± 1 months (72% (p < 0.005)). In the treatment of this category of patients, high drug resistance was noted (73–86% (p < 0.05)). Conclusion. The use of plant cannabinoids increases the risk of suicidal behavior. Depression in the structure of BD associated with plant cannabinoid addiction was characterized by resistance to therapy. An increase in anxiety levels led to compulsive suicide attempts which is a key risk factor for completed suicide.

Aggression, Impulsivity and Suicidal Behavior in Depressive Disorders: A Comparison Study between New York City (US), Madrid (Spain) and Florence (Italy).

The association of aggression and impulsivity with suicidal behavior (SB) in depression may vary across countries. This study aimed (i) to compare aggression and impulsivity levels, measured with the Brown-Goodwin Scale (BGS) and the Barratt Impulsivity Scale (BIS), respectively, between New York City (NYC) (US), Madrid (Spain) and Florence (Italy) (ANOVA); and (ii) to investigate between-site differences in the association of aggression and impulsivity with previous SB (binary logistic regression). Aggression scores were higher in NYC, followed by Florence and Madrid. Impulsivity levels were higher in Florence than in Madrid or NYC. Aggression and impulsivity scores were higher in suicide attempters than in non-attempters in NYC and in Madrid. SB was associated with aggression in NYC (OR 1.12, 95% CI 1.07–1.16; p < 0.001) and in Florence (OR 1.11, 95% CI 1.01–1.22; p = 0.032). Impulsivity was linked with SB in NYC (OR 1.01, 95% CI 1.00–1.02; p < 0.001) and in Madrid (OR 1.03, 95% CI 1.02–1.05; p < 0.001). The higher suicide rates in NYC, compared to Madrid or Florence, may be, in part, explained by these cross-cultural differences in the contribution of aggression-impulsivity to SB, which should be considered by future research on SB prevention.

Jumping to conclusions and suicidal behavior in depression and psychosis

Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99–4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.

T110. Familial Aggregation of Neurocognitive Deficits Associated With Suicidal Behavior

The association of neurocognitive deficits with suicidal behavior in depression is well established (Richard-Devantoy, et al., 2014 & 2015). Given that both this behavior (Brent et al., 2015) and traits associated with risk (Melhem et al., 2007) run in families, these neurocognitive deficits may run in families as well.

Resting-state functional MRI of abnormal baseline brain activity in young depressed patients with and without suicidal behavior

BackgroundSuicide among youth is a major public health challenge, attracting increasing attention. However, the neurobiological mechanisms and the pathophysiology underlying suicidal behavior in depressed youths are still unclear. The fMRI enables a better understanding of functional changes in the brains of young suicide attempters with depressive disorder through detecting spontaneous neural activity. The purpose of this study was to identify the relationship between abnormalities involving local brain function and suicidal attempts in depressed youths using resting-state fMRI (RS-fMRI). MethodThirty-five depressed youths aged between 15 and 29 years with a history of suicidal attempts (SU group), 18 patients without suicidal attempts (NSU group) and 47 gender-, age- and education-matched healthy controls (HC) underwent psychological assessment and R-fMRI. The differences in fractional amplitude of low-frequency fluctuation (ALFF) among the three groups were compared. The clinical factors correlated with z-score ALFF in the regions displaying significant group differences were investigated. The ROC method was used to evaluate these clusters as markers to screen patients with suicidal behavior. ResultsCompared with the NSU and HC groups, the SU group showed increased zALFF in the right superior temporal gyrus (r-STG), left middle temporal gyrus (L-MTG) and left middle occipital gyrus (L-MOG). Additionally, significantly decreased zALFF values in the L-SFG and L-MFG were found in the SU group compared with the NSU group, which were negatively correlated with BIS scores in the SU group. Further ROC analysis revealed that the mean zALFF values in these two regions (sensitivity=83.3% and specificity=71.4%) served as markers to differentiate the two patient subtypes. ConclusionThe SU group had abnormal spontaneous neural activity during the resting state, and decreased activity in L-SFG and L-MFG was associated with increased impulsivity in SU group. Our results suggested that abnormal neural activity in these brain regions may represent a potential neurobiological diathesis or predisposition to suicidal behavior in youth depression.

Dysfunction of neural circuitry in depressive patients with suicidal behaviors: A review of structural and functional neuroimaging studies

Suicide is an important public problem. Understanding the neurobiological mechanisms of suicidal behavior in depression will facilitate the development of more effective prevention strategies for suicide. There are several reviews of imaging studies of suicidal behavior, but none of these reviews have focused only on suicide in depression. We reviewed neuroimaging studies of suicide in depression in recent years. The majority of studies found structural and functional alterations in the orbital frontal cortex, anterior cingulate cortex and striatum in depressive patients with suicidal behaviors. The evidence suggests that the frontal-striatal circuitry, which includes the striatum, orbital frontal and anterior cingulate cortices, is involved in the neurobiology of suicide in depressive patients. These findings also indicate that not all suicides have the same underlying neuropathology. Future studies require larger samples and more accurate subtypes of suicide. Furthermore, combining neuroimaging and other new technologies in molecular biology will be helpful to reveal the pathogenesis of suicidal behavior in depression.

The effects of psychotherapy for adult depression on suicidality and hopelessness: A systematic review and meta-analysis

Although treatment guidelines suggest that suicidal patients with depression should be treated for depression with psychotherapy, it is not clear whether these psychological treatments actually reduce suicidal ideation or suicide risk. We conducted a systematic review and meta-analysis of studies on psychotherapy for depression in which outcomes on suicidality were reported. We also focused on outcomes on hopelessness because this is strongly associated with suicidal behavior in depression. Thirteen studies (with 616 patients) were included, three of which examined the effects of psychotherapy for depression on suicidal ideation and suicide risk, and eleven on hopelessness. No studies were found with suicide attempts or completed suicides as the outcome variables. The effects on suicidal ideation and suicide risk were small (g=0.12; 95% CI: -0.20-0.44) and not statistically significant. A power calculation showed that these studies only had sufficient power to find an effect size of g=0.47. The effects on hopelessness were large (g=1.10; 95% CI: 0.72-1.48) and significant, although heterogeneity was very high. Furthermore, significant publication bias was found. After adjustment of publication bias the effect size was reduced to g=0.60. At this point, there is insufficient evidence for the assumption that suicidality in depressed patients can be reduced with psychotherapy for depression. Although psychotherapy of depression may have small positive effects on suicidality, available data suggest that psychotherapy for depression cannot be considered to be a sufficient treatment. The effects on hopelessness are probably higher.

Functional Neural Basis of Suicidal Behavior in Depression

Functional Neural Basis of Suicidal Behavior in Depression

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.

HPA axis dysregulation and suicidal behavior in depression – Differentiation of a genetically distinct subgroup?

HPA axis dysregulation and suicidal behavior in depression – Differentiation of a genetically distinct subgroup?

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.

A clinical-psychological approach to suicidal behavior in depression from Moscow.

This contribution strives to familiarize Western readers with the theoretical concept of suicidal behavior which was developed at the Department of Suicidology of Moscow Psychiatric Research Institute and has been in use there for the last two decades. In describing this approach the paper concentrates on what differentiates it from traditional Western management without making value judgments about either approach. Such an account of the concept and its development will hopefully afford the reader an opportunity to arrive at his or her own conclusions regarding its clinical value.

A clinical-psychological approach to suicidal behavior in depression from Moscow.

A clinical-psychological approach to suicidal behavior in depression from Moscow.

Recent biologic studies on suicide.

This paper selectively reviews the author's recent studies on suicidal behavior in depression. Data are reviewed from a study of depressed patients who had monoamine metabolites measured in both the cerebrospinal fluid (CSF) and urine. Depressed patients who had attempted suicide had significantly reduced CSF concentrations of the dopamine metabolite homovanillic acid (HVA) and significantly lower urinary outputs of HVA than patients who had not attempted suicide. Similarly, patients who went on to reattempt suicide over a 5-year follow-up period had both significantly reduced CSF concentrations of HVA and lower urinary outputs of HVA than patients who did not reattempt. These data suggest a role for diminished central dopaminergic neurotransmission in suicidal behavior in depression. Patients who had made a violent suicide attempt also showed evidence of dysregulation of the hypothalamic-pituitary-adrenal axis.

Are cerebrospinal fluid or urinary monoamine metabolite measures stronger correlates of suicidal behavior in depression?

A series of depressed patients had monoamine metabolites measured in cerebrospinal fluid (CSF) and urine. We wished to see if CSF or urinary measures were more strongly associated with suicidal behavior in depression. Using a variety of graphical and analytic statistical approaches we found that the urinary measures of dopamine metabolism had the strongest association with suicide attempts in depression. These surprising results suggest that selected peripheral correlates of monoaminergic neurotransmission deserve further study in suicidal behavior.

Psychophysiological Correlates of Suicidal Behavior in Depression

P300 and contingent negative variation (CNV) were recorded in depressive inpatients with and without history of suicide attempt. The results show a significant reduction of both P300 and CNV in patients who had attempted suicide as compared with patients who had not. Moreover, a significant correlation was found between the suicidal risk scale and CNV amplitude. Psychophysiological and biochemical implications are discussed.

Neuropeptides in relation to suicidal behavior in depression.

Neuropeptides were examined in relation to suicidal behavior and its repetition in depression. There were no significant differences between depressed patients who had or had not attempted suicide for cerebrospinal fluid (CSF) concentrations of neuropeptide Y, somatostatin, diazepam-binding inhibitor, GABA, or corticotropin releasing hormone. A 5-year follow-up was carried out. There were no significant differences between depressed patients who did or did not reattempt suicide during the follow-up or who had never attempted for CSF concentrations of any of the neuropeptides measured. These negative results suggest that these neuropeptides are probably not major determinants of suicidal behavior or its repetition in depression.

Hypothalamic-pituitary-adrenal axis function and suicidal behavior in depression

Hypothalamic-pituitary-adrenal (HPA) axis function was examined in relation to suicidal behavior in depression. There were no significant differences between depressed patients who had or had not attempted suicide for either cerebrospinal fluid concentrations of corticotropin-releasing hormone, plasma cortisol levels predexamethasone or postdexamethasone, or for urinary-free cortisol outputs. However, depressed patients who had made a violent suicide attempt had significantly higher 4 pm and maximum postdexamethasone plasma cortisol levels, and significantly more of them were cortisol nonsuppressors than patients who had made nonviolent suicide attempts. A 5-year follow-up was carried out. There were no significant differences on indices of HPA function between depressed patients who did or did not reattempt suicide during the follow-up or who had never attempted suicide. These results suggest the possibility that dysregulation of the HPA axis may be a determinant of violent suicidal behavior in depression.

Marked reduction in indexes of dopamine metabolism among patients with depression who attempt suicide.

Cerebrospinal fluid studies have reported that low concentrations of the dopamine metabolite homovanillic acid are associated with suicidal behavior in depression. Although only a small proportion of homovanillic acid in the urine derives from the brain, we decided to examine 24-hour urinary outputs of homovanillic acid in relation to suicidal behavior in depression. Patients with depression who had attempted suicide had significantly smaller urinary outputs of homovanillic acid, dihydroxyphenylacetic acid, and total body output of dopamine (sum dopamine) than did patients with depression who had not attempted suicide. Patients with depression who reattempted suicide during 5-year follow-up had significantly smaller urinary outputs of homovanillic acid and sum dopamine than did patients who did not reattempt suicide, patients who never attempted suicide, and normal control subjects, and had significantly smaller outputs of dihydroxyphenylacetic acid than patients who never attempted suicide or control subjects. These data suggest that urinary outputs of homovanillic acid may be peripheral correlates of suicidality in depression. These data add to data on the low levels of homovanillic acid in cerebrospinal fluid in suggesting that diminished dopaminergic neurotransmission may play a part in suicidal behavior in depression.