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.
Gender differences in prevalence rates of suicide attempts and suicidal thoughts as well as in risk factors for suicide attempts such as traumatic events and mental disorders were investigated in a ...random sample of 3021 adolescents aged 14-24 years.
The M-CIDI (Composite International Diagnostic Interview) was used to survey suicidal behaviour, DSM-IV lifetime diagnoses and traumatic events.
The female suicide attempters showed suicidal thoughts and suicide attempts significantly more often, and suicide attempts at a much younger age than the males. Furthermore, the females experienced sexual abuse much more often, and suffered significantly more often from anxiety disorders. The male suicide attempters showed higher rates of alcohol disorders and financial problems.
A higher rate of anxiety in female suicide attempters results probably as a consequence of sexual abuse, which in turn makes them more vulnerable than males for attempting suicide between the age of 14-17.
According to some reports, patients treated with risperidone may develop akathisia. Restless legs syndrome (RLS), which shares some clinical features with akathisia, is a distinct movement and sleep ...disorder that may be induced by various drugs that act on the CNS.
We studied a 31-year-old patient suffering from a schizoaffective disorder including auditory hallucinations who developed symptoms typical of the RLS during treatment with risperidone, using polysomnography to objectify sleep disturbances and associated periodic leg movements during sleep (PLMS).
After switching from clozapine to risperidone treatment, the patient complained about dysethesias primarily of the legs, an urge to walk around, and sleep disturbances. The latter could be confirmed by polysomnography, including an abnormal PLMS index. Risperidone was switched to haloperidol. However, RLS symptoms were still present. After switching to quetiapine, RLS symptoms vanished and a second polysomnography test demonstrated better sleep quality and normal PLMS measurements. During the whole treatment period with different neuroleptics, the patient additionally received valproic acid.
Symptoms typical of RLS may be induced by risperidone treatment and should be differentiated from akathisia. Although polysomnography is not necessary, it may be helpful confirming the diagnosis.
Epidemiological and clinical studies have described an association between lower serum cholesterol concentrations and increased suicide risk that is not entirely attributable to depression-related ...malnutrition and weight loss. Recent epidemiological studies with greater samples and longer follow-up periods, however, have even shown a positive correlation between cholesterol concentrations and suicide risk after controlling for potential confounding variables. A meta-analysis of earlier intervention trials suggested that cholesterol lowering could cause or worsen depressive symptoms and increase the risk of suicide. Large trials of statins (simvastatin, lovastatin, and pravastatin) did not show an increase of suicide mortality. The aim of this selective review is to critically discuss the current evidence for a potential link between cholesterol, essential fatty acids, depression, suicide, impulsivity, and aggression. Preclinical data support the hypothesis that cholesterol reduction may contribute to the serotonergic abnormalities that have been postulated in suicidal subjects. Recently, it was hypothesised that a decreased consumption of polyunsaturated fatty acids, especially omega-3 fatty acids, may be a risk factor for depression and suicide. Currently, we do not have sufficient evidence that cholesterol-lowering therapies increase the risk of depression and suicide. Increasing the dietary intake of omega-3 fatty acids may increase central serotonergic activity and reduce impulsive and aggressive behaviours.
The role of comorbidity as a risk for suicide attempts is investigated in a random sample of 3021 young adults aged 14-24 years. The M-CIDI, a fully standardized and modified version of the Composite ...International Diagnostic Interview, was used for the assessment of various DSM-IV lifetime and 12-month diagnoses as well as suicidal ideation and suicide attempts. Of all suicide attempters, 91% had at least one mental disorder, 79% were comorbid or multimorbid respectively and 45% had four or more diagnoses (only 5% in the total sample reached such high levels of comorbidity). Suicide attempters with more than three diagnoses were 18 times more likely (OR = 18.4) to attempt suicide than subjects with no diagnosis. Regarding specific diagnoses, multivariate comorbidity analyses indicated the highest risk for suicide attempt in those suffering from anxiety disorder (OR = 4.3), particularly posttraumatic stress disorder followed by substance disorder (OR = 2.2) and depressive disorder (OR = 2.1). Comorbidity, especially when anxiety disorders are involved, increases the risk for suicide attempts considerably more than any other individual DSM-IV diagnoses.
Objective Low platelet 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. 59 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 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 suicide attempt 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.
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.
Carbamazepine is effective in the treatment of acute mania and in the prevention of episodes in bipolar disorder, and it may also be useful in depression, impulse-control disorder and withdrawal from ...alcohol and benzodiazepine dependence. A potentially life-threatening side effect is the anticonvulsant hypersensitivity syndrome. Here, we describe a patient who developed severe auditory hallucinations followed by a distinct hypersensitivity syndrome most likely induced by carbamazepine treatment.
The effect of comorbidity on rates of suicidal ideation and suicide attempts from an adult general population of former West Germany is investigated. The assessment instrument is a modified German ...version of the Diagnostic Interview Schedule (DIS), a fully standardized interview for the assessment of selected DSM-III lifetime diagnoses as well as suicidal ideation and suicide attempts. Of the general population 4.1% (2.2% male and 4.1% female) made suicide attempts during their lifetime. Only 2 of 18 people who attempted suicide did not meet criteria for a DSM-III-R diagnosis. Cases with pure major depression did not have an odds ratio for suicide attempts significantly higher than subjects with no DSM-III diagnosis. However, cases with both a major depression and a lifetime-anxiety-disorder diagnosis showed significantly elevated odds ratios. Therefore, it is suggested that comorbidity of anxiety and depression, and not depression itself, seems to be a risk factor for suicide attempts.
PDF
