Assessment of Suicide Risk in Patients with Depressive Episodes Due to Affective Disorders and Borderline Personality Disorder: A Pilot Comparative Study.

This study assessed suicidal risk in patients suffering from non-psychotic depressive disorders within various clinical and nosological forms (F31-F34 mood disorders and F60.31-emotionally unstable personality disorder). Clinical and psychological features were presented, as well as predictors of suicidal risk in patients of these groups. We performed a comparative analysis of the anxiety and depression level, the level of mental pain, fear of death and the severity of anti-suicidal motives in patients with affective disorders and borderline personality disorder (BPD). Based on the results, 100% of patients in these clinical nosological groups were found to have a high level of suicidal risk. Patients with affective disorders have weak anti-suicidal motives and are not fully aware of the consequences of their own death. Patients with BPD have a higher suicidal risk than patients with affective disorders; they are characterized by less pronounced social orientation, demonstrativeness, self-centeredness, less pronounced levels of anxiety and fear of death.

Effective Connectivity Between the Orbitofrontal Cortex and the Precuneus Differentiates Major Psychiatric Disorders: Results from a Transdiagnostic Spectral DCM Study.

BACKGROUND & OBJECTIVE: We have previously identified aberrant connectivity of the left precuneus, ventrolateral prefrontal cortex, anterior cingulate cortex, and anterior insula in patients with either a paranoid (schizophrenia), or a depressive syndrome (both unipolar and bipolar). In the current study, we attempted to replicate and expand these findings by including a healthy control sample and separating the patients in a depressive episode into two groups: unipolar and bipolar depression. We hypothesized that the connections between those major nodes of the resting state networks would demonstrate different patterns in the three patient groups compared to the healthy subjects. METHODS: Resting-state functional MRI was performed on a sample of 101 participants, of which 26 patients with schizophrenia (current psychotic episodes), 24 subjects with Bipolar Disorder (BD), 33 with Major Depressive Disorder (MDD) (both BD and MDD patients were in a current depressive episode), and 21 healthy controls. Spectral Dynamic Causal Modeling was used to calculate the coupling values between eight regions of interest, including the anterior precuneus (PRC), anterior hippocampus, anterior insula, angular gyrus, lateral Orbitofrontal Cortex (OFC), middle frontal gyrus, planum temporale, and anterior thalamus. RESULTS & CONCLUSION: We identified disturbed effective connectivity from the left lateral orbitofrontal cortex to the left anterior precuneus that differed significantly between unipolar depression, where the influence was inhibitory, and bipolar depression, where the effect was excitatory. A logistic regression analysis correctly classified 75% of patients with unipolar and bipolar depression based solely on the coupling values of this connection. In addition, patients with schizophrenia demonstrated negative effective connectivity from the anterior PRC to the lateral OFC, which distinguished them from healthy controls and patients with major depression. Future studies with unmedicated patients will be needed to establish the replicability of our findings.

Suicidal behaviour and aggression in psychiatric inpatients.

OBJECTIVE: Theoretically, suicidal behaviour and aggression are usually said to be correlated. Such relationship is, however, not reliably supported by clinical and experimental evidence. It has been more frequently found when suicidal psychiatric patients are compared with healthy non-suicidal controls rather than when the comparison is done within the group of the psychiatric patients. Therefore we decided to investigate whether such relationship exists in a group with a high risk of suicidal behaviour--psychiatric male inpatients. MATERIAL AND METHODS: 113 male inpatients, mostly with schizophrenia and other psychotic disorders and mood disorders were studied in the first five days after their admission. Using a structured clinical interview and formal rating scales data were collected about the number of suicide attempts and aggressive acts committed throughout their lives, current suicide ideation and suicide planning behaviour, alcohol use, depression and outwardly directed aggression. Correlation analysis and chi-square test were used to analyze the data. RESULTS: There is no significant relation between current aggressivity and current suicide risk, as well as between the lifetime aggression and the lifetime suicide behaviour. The current suicide ideation and suicide planning behaviour are related to previous suicidal behaviour and to the current depression level. The lifetime aggression is related to the alcohol use. CONCLUSIONS: The results of our study do not define aggression as a suicide risk factor within the group of psychiatric inpatients. This findings could benefit the evaluation of the suicidal risk in psychiatric clinic.