Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo-controlled, 1-year trial.

OBJECTIVE: Evidence based on controlled studies is still limited for treatment strategies that prevent recurrence of suicide attempts. Findings from observational as well as meta-analytic studies strongly suggest that lithium may have suicide-protective properties. METHOD: Patients with a recent suicide attempt in the context of an affective spectrum disorder (n = 167) were treated with either lithium or placebo during a 12-month period. RESULTS: Survival analysis showed no significant difference of suicidal acts between lithium and placebo-treated individuals (adjusted hazard ratio 0.517; 95% CI 0.18-1.43). However, post hoc analysis revealed that all completed suicides had occurred in the placebo group accounting for a significant difference in incidence rates (P = 0.049). CONCLUSION: Results indicate that lithium treatment might be effective in reducing the risk of completed suicide in adult patients with affective disorders. Our findings contribute to the growing body of evidence suggesting a specific antisuicidal effect of lithium.

Is MAO-B activity in platelets associated with the occurrence of suicidality and behavioural personality traits in depressed patients?

OBJECTIVE: Low platelet monoaminoxidase B (MAO-B) activity has been associated with various forms of impulsive behaviour and suicidality. The present study investigated the relationship between MAO-B activity in platelets and aspects of suicidality in depressed patients and controls. METHOD: In 87 patients with affective spectrum disorders (58% suffering from a major depressive episode - MDE) the potential association between platelet MAO-B activity and suicidality was examined. Fifty-nine of the patients had committed suicide attempt recently (SA -'suicide attempters'), 28 patients were acutely depressed without having shown suicidal thoughts or suicidal behaviour in the past (NA -'non-suicide attempters'). RESULTS: The SA and NA were comparable as to their diagnoses and general demographic and psychopathological parameters. MAO-B activity did not differ between SA and NA. No systematic correlations existed between MAO-B activity and any dimensions of suicidal behaviour or psychopathology. As a single finding only a weak positive association of higher MAO-B activity in SA with a fatal intention of the SA was observed. CONCLUSION: Our findings do not support a consistent association of platelet MAO-B activity and suicidal behaviour in general, but specific facts of suicidality might be associated.

[Suicide in the literary work of Walker Percy]. / Der Selbstmord im literarischen Werk von Walker Percy.

Suicidality is one of the most serious unsolved problems of modern psychiatry. The psychological analysis of the behavioral and meaning patterns of suicide in the work of W. Percy gives the opportunity to a better and wider understanding of this phenomenon. In the suicide discussion, Percy points out the primary human need of transcendence and symbolization and the meaning of the "experience on the border" with its sense inducing character.

The risk of acute suicidality in psychiatric inpatients increases with low plasma cholesterol.

Several studies suggest that the reduction of total cholesterol in blood by lipid-lowering agents is accompanied by a decrease in the incidence of coronary heart disease, but not in total mortality. Likewise, epidemiological studies show that low total cholesterol concentrations appear to be associated with an increased risk of death from suicide and injuries. There is little information with respect to acute suicidality and cholesterol in psychiatric inpatients; therefore the aim of the present study was to examine exactly this relation between plasma cholesterol and acute suicidality. The study comprised 45 acutely suicidal psychiatric inpatients, 95 nonsuicidal inpatients with affective disorder, and 20 healthy subjects. Psychopathological measures (Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, Beck's Suicide Intent Scale) were established in these patients as well as the plasma concentrations of cholesterol in patients and healthy subjects. The most important finding of this study is that the risk of acute suicidality decreases with increasing total cholesterol levels irrespective of age, gender, and nutritional status (i.e., body mass index). Comparison of total cholesterol levels between age- and sex-matched suicidal and nonsuicidal patients with affective disorder supports this observation: Despite the slightly higher body mass index, suicidal patients have significantly lower cholesterol levels than nonsuicidal patients. Our findings support the notion that acute suicidality is associated with low plasma cholesterol; this observation needs to be further studied in the context of a biological marker for suicide risk.

[Violent and non-violent methods of parasuicide: what determines the choice?]. / Harte und weiche Methoden des Parasuizids: was bestimmt die Wahl?

UNLABELLED: Patients with violent methods of parasuicide share a number of common characteristics with those who complete suicide. They can be differentiated from patients with non-violent methods. Whereas surgery is usually the first-line care in cases of violent parasuicide, detoxification and/or psychiatric hospitalisation are first employed with non-violent parasuicide. Therefore it is important to know the specific needs and characteristics of both patient groups, as it may be hypothesised that patients with violent methods are at specifically high risk of committing suicide. As part of the WHO/EURO Multicentre Study on Parasuicide, we examined 120 cases of parasuicide in hospitals of the Bonn area with the instrument EPSIS 1. Violent and non-violent methods were differentiated following the WHO X-classification. RESULTS: The following independent variables differentiate between violent and non-violent methods and predict the choice of violent methods: Diagnosis (schizophrenia vs. other diagnoses, p = 0.00027), gender (male, p = 0.04), high score of anger as a trait in State-Trait-Anger Scale (p = 0.017), poor mental health within the last 3 months (p = 0.058), time of parasuicide after 6 p.m. (p = 0.024). A higher number of previous parasuicides (p = 0.008) and unemployment (p = 0.047) were predictive of the choice of non-violent methods. A logistic regression analysis generated a model including the independent variables diagnosis, gender and "anger". Suicidal intent, sociodemographic variables, motives of parasuicides and "life events" did not discriminate between violent and non-violent methods.

Special feature: family-genetic research strategies for personality disorders.

Personality disorders (PD) might be considered as extremes of personality dimensions varying in the general population or as attenuated variants of major psychiatric disorders. Both personality variation and major psychiatric disorders have been shown in twin and adoption studies, to be influenced by genes. Hence, it is likely that personality disorders are also under genetic control. However, direct evidence for influential familial and genetic factors is scarce. Various research strategies in this area are described and current evidence is reported. Gene-oriented approaches seem to be particularly promising. This strategy is illustrated for personality disorders in obligate carriers of mutations in the fragile-X gene.

Upregulation of the platelet Serotonin2A receptor and low blood serotonin in suicidal psychiatric patients.

Suicidality has been found to be associated with low pre- and postsynaptic serotonin functioning. The purpose of this study was to examine whether in acutely suicidal psychiatric inpatients, the blood serotonin concentration was related to the underlying psychiatric disorder and whether it was associated with changes in the affinity (dissociation constant, KD) or in the maximal binding capacity (Bmax) of the platelet serotonin2A receptor. We therefore determined the blood serotonin concentrations and the platelet serotonin2A receptor activities of 45 suicidal psychiatric patients and 20 healthy subjects. We found that the blood serotonin concentrations were significantly lower in suicidal patients compared to healthy subjects. In all diagnostic categories (affective disorder, schizophrenia and adjustment disorder) we noted a significantly higher maximal binding capacity of the platelet serotonin2A receptor. These findings support the notion that a reduction in the availability of serotonin and an upregulation of the serotonin2A receptors in psychiatric patients are associated with a loss of control over suicidal impulses.

Effects of fluoxetine versus bright light in the treatment of seasonal affective disorder.

BACKGROUND: Disturbances of serotonergic neurotransmission appear to be particularly important for the pathophysiology of winter depression. This study investigated whether fluoxetine has antidepressant effects comparable to bright light in the treatment of seasonal affective disorder (winter type). METHOD: A randomized, parallel design was used with rater and patients blind to treatment conditions. One week of placebo (phase I) was followed by 5 weeks of treatment (phase II) with fluoxetine (20 mg per day) and a placebo light condition versus bright light (3000 lux, 2 h per day) and a placebo drug. There were 40 patients (20 in each treatment condition) suffering from seasonal affective disorder (SAD) according to DSM-III-R who had a total score on the Hamilton Depression Scale of at least 16. RESULTS: Forty patients entered phase II and 35 completed it (one drop-out in the fluoxetine group and four in the bright light group). Fourteen (70%) of the patients treated with bright light and 13 (65%) of those treated with fluoxetine were responders (NS). The remission rate in the bright light group tended to be superior (bright light 50%, fluoxetine 25%; P = 0.10). Light therapy improved HDRS scores significantly faster, while fluoxetine had a faster effect on atypical symptoms. Light treatment in the morning produced a significantly faster onset of improvement, but at the end of treatment the time of light application seemed not to be crucial. CONCLUSION: Both treatments produced a good antidepressant effect and were well tolerated. An apparently better response to bright light requires confirmation in a larger sample.