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Kim S, Park J, Lee H, Lee H, Woo S, Kwon R, Kim S, Koyanagi A, Smith L, Rahmati M, Fond G, Boyer L, Kang J, Lee JH, Oh J, Yon DK. Global public concern of childhood and adolescence suicide: a new perspective and new strategies for suicide prevention in the post-pandemic era. World J Pediatr 2024:10.1007/s12519-024-00828-9. [PMID: 39008157 DOI: 10.1007/s12519-024-00828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Suicide is the second leading cause of death in young people worldwide and is responsible for about 52,000 deaths annually in children and adolescents aged 5-19 years. Familial, social, psychological, and behavioral factors play important roles in suicide risk. As traumatic events such as the COVID-19 pandemic may contribute to suicidal behaviors in young people, there is a need to understand the current status of suicide in adolescents, including its epidemiology, associated factors, the influence of the pandemic, and management initiatives. DATA SOURCES We investigated global and regional suicide mortality rates among children and adolescents aged 5-19 years using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The suicide mortality rates from 1990 to 2019 were examined in 204 countries and territories across six World Health Organization (WHO) regions. Additionally, we utilized electronic databases, including PubMed/MEDLINE and Scopus, and employed various combinations of terms such as "suicide", "adolescents", "youth", "children", "risk factors", "COVID-19 pandemic", "prevention", and "intervention" to provide a narrative review on suicide within the pediatric population in the post-pandemic era. RESULTS Despite the decreasing trend in the global suicide mortality rate from 1990 to 2019, it remains high. The mortality rates from suicide by firearms or any other specified means were both greater in males. Additionally, Southeast Asia had the highest suicide rate among the six WHO regions. The COVID-19 pandemic seems to contribute to suicide risk in young people; thus, there is still a strong need to revisit appropriate management for suicidal children and adolescents during the pandemic. CONCLUSIONS The current narrative review integrates up-to-date knowledge on suicide epidemiology and the effects of the COVID-19 pandemic, risk factors, and intervention strategies. Although numerous studies have characterized trends in suicide among young people during the pre-pandemic era, further studies are required to investigate suicide during the pandemic and new strategies for suicide prevention in the post-pandemic era. It is necessary to identify effective prevention strategies targeting young people, particularly those at high risk, and successful treatment for individuals already manifesting suicidal behaviors. Care for suicidal children and adolescents should be improved with parental, school, community, and clinical involvement.
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Affiliation(s)
- Soeun Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jaeyu Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Hayeon Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Selin Woo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-e-Asr University of Rafsanjan, Rafsanjan, Iran
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Guillaume Fond
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Center, Assistance Publique-Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Jiseung Kang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Jun Hyuk Lee
- Health and Human Science, University of Southern California, Los Angeles, CA, USA
| | - Jiyeon Oh
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Precision Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea.
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
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Hussain AA, Carlsson J, Mortensen EL, Hemmingsen SD, Bulik CM, Støving RK, Sjögren JM. A naturalistic study of plasma lipid alterations in female patients with anorexia nervosa before and after weight restoration treatment. J Eat Disord 2024; 12:92. [PMID: 38956654 PMCID: PMC11221051 DOI: 10.1186/s40337-024-01055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Plasma lipid concentrations in patients with anorexia nervosa (AN) seem to be altered. METHODS We conducted a naturalistic study with 75 adult female patients with AN and 26 healthy female controls (HC). We measured plasma lipid profile, sex hormones and used self-report questionnaires at admission and discharge. RESULTS Total cholesterol (median (IQR): 4.9 (1.2)) and triglycerides (TG) (1.2 (0.8)) were elevated in AN at admission (BMI 15.3 (3.4)) compared with HC (4.3 (0.7), p = 0.003 and 0.9 (0.3), p = 0.006) and remained elevated at discharge (BMI 18.9 (2.9)) after weight restoration treatment. Estradiol (0.05 (0.1)) and testosterone (0.5 (0.7)) were lower in AN compared with HC (0.3 (0.3), p = < 0.001 and 0.8 (0.5), p = 0.03) and remained low at discharge. There was no change in eating disorder symptoms. Depression symptoms decreased (33 (17) to 30.5 (19), (p = 0.007)). Regression analyses showed that illness duration was a predictor of TG, age was a predictor of total cholesterol and LDL, while educational attainment predicted LDL and TG. CONCLUSION Lipid concentrations remained elevated following weight restoration treatment, suggesting an underlying, premorbid dysregulation in the lipid metabolism in AN that persists following weight restoration. Elevated lipid concentrations may be present prior to illness onset in AN. LEVEL OF EVIDENCE III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Alia Arif Hussain
- Eating Disorder Research Unit, Mental Health Center, Ballerup, Copenhagen University Hospital - Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen University Hospital - Mental Health Services of the Capital Region of Denmark, Maglevænget 21, 2750 Ballerup, Copenhagen, Denmark.
| | - Erik Lykke Mortensen
- Unit of Medical Psychology, Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Simone Daugaard Hemmingsen
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - René Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Magnus Sjögren
- Eating Disorder Research Unit, Mental Health Center, Ballerup, Copenhagen University Hospital - Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark
- Department of Psychiatry, Institute of Clinical Science, Umeå University, Umeå, Sweden
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Liu J, Tong R, Lu Z, Wang Z, Wang Y, Liu Y, Yuan H, Jia F, Zhang X, Li Z, Du X, Zhang X. Development and validation of a nomogram for suicide attempts in patients with first-episode drug-naïve major depressive disorder. Front Psychiatry 2024; 15:1398733. [PMID: 38903642 PMCID: PMC11187325 DOI: 10.3389/fpsyt.2024.1398733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Objective The risk of suicide can be decreased by accurately identifying high-risk suicide groups and implementing the right interventions. The aim of this study was to develop a nomogram for suicide attempts (SA) in patients with first-episode drug-naïve (FEDN) major depressive disorder (MDD). Methods This study undertook a cross-sectional analysis of 1,718 patients diagnosed with FEDN MDD, providing comprehensive clinical data from September 2016 to December 2018. Data on anthropometric and sociodemographic factors were gathered, and the severity of depression and anxiety was evaluated using the 17-item Hamilton Depression Scale (HAMD-17) and the Hamilton Anxiety Scale (HAMA), respectively. Additionally, thyroid hormone levels, lipid profile parameters, and fasting blood glucose (FBG) were measured. Suicide attempt (SA) history was verified based on an amalgamation of medical records, patient interviews, and family interviews. Participants were randomly divided into a training group (70%, n = 1,204) and a validation group (30%, n = 514). In the training group, LASSO analysis and multivariate regression were used to identify variables associated with SA. A nomogram was then constructed using the identified risk factors to estimate the likelihood of SA within the training group. To assess the accuracy, the area under the receiver operating characteristic curve (AUC) was utilized, and calibration plots were employed to evaluate calibration. Additionally, decision curve analysis (DCA) was performed to assess the precision of the model. Finally, internal validation was carried out using the validation group. Results A practical nomogram has been successfully constructed, incorporating HAMD, HAMA, thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and systolic blood pressure (SBP) parameters, to estimate the probability of SA in Chinese patients diagnosed with FEDN MDD. The pooled area under the ROC for SA risk in both the training and validation groups was found to be 0.802 (95% CI: 0.771 to 0.832) and 0.821 (95% CI: 0.774 to 0.868), respectively. Calibration analysis revealed a satisfactory correlation between the nomogram probabilities and the actual observed probabilities. The clinical applicability of the nomogram was confirmed through decision curve analysis. To enhance accessibility for clinicians and researchers, an online version of the nomogram can be accessed at https://doctorjunjunliu.shinyapps.io/dynnomapp/. Conclusions We constructed and validated a nomogram for the early detection of FEDN MDD patients with a high risk of SA, thereby contributing to the implementation of effective suicide prevention programs.
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Affiliation(s)
- Junjun Liu
- Nanjing Meishan Hospital, Nanjing, China
- Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | | | - Zhaomin Lu
- Nanjing Meishan Hospital, Nanjing, China
| | - Zhiye Wang
- Nanjing Meishan Hospital, Nanjing, China
| | | | - Yang Liu
- Nanjing Meishan Hospital, Nanjing, China
| | | | - Fengnan Jia
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiaobin Zhang
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Zhe Li
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- Soochow University, Suzhou, China
- Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangyang Zhang
- Chinese Academy of Sciences (CAS) Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Tymofiyeva O, Ho TC, Connolly CG, Gorrell S, Rampersaud R, Darrow SM, Max JE, Yang TT. Examining putamen resting-state connectivity markers of suicide attempt history in depressed adolescents. Front Psychiatry 2024; 15:1364271. [PMID: 38903634 PMCID: PMC11187256 DOI: 10.3389/fpsyt.2024.1364271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/24/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Suicide is a current leading cause of death in adolescents and young adults. The neurobiological underpinnings of suicide risk in youth, however, remain unclear and a brain-based model is lacking. In adult samples, current models highlight deficient serotonin release as a potential suicide biomarker, and in particular, involvement of serotonergic dysfunction in relation to the putamen and suicidal behavior. Less is known about associations among striatal regions and relative suicidal risk across development. The current study examined putamen connectivity in depressed adolescents with (AT) and without history of a suicide attempt (NAT), specifically using resting-state functional magnetic resonance imaging (fMRI) to evaluate patterns in resting-state functional connectivity (RSFC). We hypothesized the AT group would exhibit lower striatal RSFC compared to the NAT group, and lower striatal RSFC would associate with greater suicidal ideation severity and/or lethality of attempt. Methods We examined whole-brain RSFC of six putamen regions in 17 adolescents with depression and NAT (MAge [SD] = 16.4[0.3], 41% male) and 13 with AT (MAge [SD] = 16.2[0.3], 31% male). Results Only the dorsal rostral striatum showed a statistically significant bilateral between-group difference in RSFC with the superior frontal gyrus and supplementary motor area, with higher RSFC in the group without a suicide attempt compared to those with attempt history (voxel-wise p<.001, cluster-wise p<.01). No significant associations were found between any putamen RSFC patterns and suicidal ideation severity or lethality of attempts among those who had attempted. Discussion The results align with recent adult literature and have interesting theoretical and clinical implications. A possible interpretation of the results is a mismatch of the serotonin transport to putamen and to the supplementary motor area and the resulting reduced functional connectivity between the two areas in adolescents with attempt history. The obtained results can be used to enhance the diathesis-stress model and the Emotional paiN and social Disconnect (END) model of adolescent suicidality by adding the putamen. We also speculate that connectivity between putamen and the supplementary motor area may in the future be used as a valuable biomarker of treatment efficacy and possibly prediction of treatment outcome.
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Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Tiffany C. Ho
- Department of Psychology, Brain Research Institute, Interdepartmental Graduate Program in Neuroscience, University of California, Los Angeles, Los Angeles, CA, United States
| | - Colm G. Connolly
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL, United States
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Ryan Rampersaud
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Sabrina M. Darrow
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California San Francisco, San Francisco, CA, United States
| | - Jeffrey E. Max
- Department of Psychiatry, University of California San Diego, San Diego, CA, United States
- Department of Psychiatry, Rady Children’s Hospital, San Diego, CA, United States
| | - Tony T. Yang
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of California San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
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Qin K, Li H, Zhang H, Yin L, Wu B, Pan N, Chen T, Roberts N, Sweeney JA, Huang X, Gong Q, Jia Z. Transcriptional Patterns of Brain Structural Covariance Network Abnormalities Associated With Suicidal Thoughts and Behaviors in Major Depressive Disorder. Biol Psychiatry 2024:S0006-3223(24)00075-1. [PMID: 38316331 DOI: 10.1016/j.biopsych.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/07/2024] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Although brain structural covariance network (SCN) abnormalities have been associated with suicidal thoughts and behaviors (STBs) in individuals with major depressive disorder (MDD), previous studies have reported inconsistent findings based on small sample sizes, and underlying transcriptional patterns remain poorly understood. METHODS Using a multicenter magnetic resonance imaging dataset including 218 MDD patients with STBs, 230 MDD patients without STBs, and 263 healthy control participants, we established individualized SCNs based on regional morphometric measures and assessed network topological metrics using graph theoretical analysis. Machine learning methods were applied to explore and compare the diagnostic value of morphometric and topological features in identifying MDD and STBs at the individual level. Brainwide relationships between STBs-related connectomic alterations and gene expression were examined using partial least squares regression. RESULTS Group comparisons revealed that SCN topological deficits associated with STBs were identified in the prefrontal, anterior cingulate, and lateral temporal cortices. Combining morphometric and topological features allowed for individual-level characterization of MDD and STBs. Topological features made a greater contribution to distinguishing between patients with and without STBs. STBs-related connectomic alterations were spatially correlated with the expression of genes enriched for cellular metabolism and synaptic signaling. CONCLUSIONS These findings revealed robust brain structural deficits at the network level, highlighting the importance of SCN topological measures in characterizing individual suicidality and demonstrating its linkage to molecular function and cell types, providing novel insights into the neurobiological underpinnings and potential markers for prediction and prevention of suicide.
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Affiliation(s)
- Kun Qin
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Department of Radiology, Taihe Hospital, Hubei University of Medicine, Shiyan, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Huiru Li
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Huawei Zhang
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Li Yin
- Department of Psychiatry, West China Hospital of Sichuan University, Chengdu, China
| | - Baolin Wu
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Nanfang Pan
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Taolin Chen
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Neil Roberts
- Queens Medical Research Institute, School of Clinical Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - John A Sweeney
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio
| | - Xiaoqi Huang
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, Fujian, China.
| | - Zhiyun Jia
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China; Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.
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Hussain AA, Bilgin M, Carlsson J, Foged MM, Mortensen EL, Bulik CM, Støving RK, Sjögren JM. Elevated lipid class concentrations in females with anorexia nervosa before and after intensive weight restoration treatment-A lipidomics study. Int J Eat Disord 2023; 56:2260-2272. [PMID: 37715358 DOI: 10.1002/eat.24063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To study the plasma lipidome of patients with anorexia nervosa (AN) before and after weight restoration treatment and report associations with AN subtypes and oral contraceptive pill (OCP) usage. METHODS Quantitative shotgun lipidomics analysis was used to study plasma lipids of 50 female patients with AN before and after weight restoration treatment and 50 healthy female controls (HC). The AN group was assessed with blood samples and questionnaires before and after weight restoration. RESULTS In total we quantified 260 lipid species representing 26 lipid classes of which 13 lipid class concentrations were elevated in patients with AN at admission compared with HC. Lipid classes remained elevated after weight restoration treatment of 84 days (median; interquartile range 28), and only the concentration of the ceramide lipid class increased between pre- and post-treatment (p = .03), whereas lysophosphatidylcholine (LPC, p = .02), ether-linked Phosphatidylcholine (LPCO, p = .02), and lysophosphatidylethanolamine (LPE, p = .009) decreased. CONCLUSION In AN, 13 out of 26 lipid class concentrations were elevated at admission and remained elevated post-treatment. Ceramides increased further between pre- and post-weight restoration treatment, which could be related to the rapid weight gain during re-nutrition. Further research is needed to elucidate the effects of weight restoration treatment on short- and long-term lipid profiles in individuals with AN. PUBLIC SIGNIFICANCE STATEMENT Lipidomics research can increase the understanding of AN, a complex and potentially life-threatening eating disorder. By analyzing lipids, or fats, in the body, we can identify biological markers that may inform diagnosis and develop more effective treatments. This research can also shed light on the underlying mechanisms of the disorder, leading to a better understanding of the processes involved in eating behavior.
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Affiliation(s)
- Alia Arif Hussain
- Eating Disorder Research Unit, Mental Health Center, Ballerup, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mesut Bilgin
- Lipidomics Core Facility, Danish Cancer Institute, Copenhagen, Denmark
| | - Jessica Carlsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region of Denmark, Copenhagen, Denmark
| | - Mads Møller Foged
- Lipidomics Core Facility, Danish Cancer Institute, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Unit of Medical Psychology, Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - René Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Magnus Sjögren
- Eating Disorder Research Unit, Mental Health Center, Ballerup, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Institute of Clinical Science, Department of Psychiatry, Umeå University, Umeå, Sweden
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Bartlett EA, Zanderigo F, Stanley B, Choo TH, Galfalvy HC, Pantazatos SP, Sublette ME, Miller JM, Oquendo MA, Mann JJ. In vivo serotonin transporter and 1A receptor binding potential and ecological momentary assessment (EMA) of stress in major depression and suicidal behavior. Eur Neuropsychopharmacol 2023; 70:1-13. [PMID: 36780841 PMCID: PMC10121874 DOI: 10.1016/j.euroneuro.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/13/2023]
Abstract
We examined relationships between the serotonin system and stress in major depression and suicidal behavior. Twenty-five medication-free depressed participants (13 suicide attempters) underwent same-day [11C]DASB and [11C]CUMI-101 positron emission tomography (PET) imaging. Binding potential (BPND) to the serotonin transporter (5-HTT) and serotonin 1A (5-HT1A) receptor, respectively, was quantified using the NRU 5-HT atlas, reflecting distinct spatial distributions of multiple serotonin targets. Ecological momentary assessment (EMA) measured current stress over one week proximal to imaging. EMA stress did not differ between attempters and non-attempters. In all depressed participants, 5-HTT and 5-HT1A BPND were unrelated to EMA stress. There were region-specific effects of 5-HTT (p=0.002) and 5-HT1A BPND (p=0.03) in attempters vs. nonattempters. In attempters, region-specific associations between 5-HTT (p=0.03) and 5-HT1A (p=0.005) BPND and EMA stress emerged. While no post-hoc 5-HTT BPND correlations were significant, 5-HT1A BPND correlated positively with EMA stress in attempters in 9/10 regions (p-values<0.007), including the entire cortex except the largely occipital region 5. Brodmann-based regional analyses found diminished effects for 5-HTT and subcortically localized positive corrrelations between 5-HT1A and EMA stress, in attempters only. Given comparable depression severity and childhood and current stress between attempters and nonattempters, lower 5-HTT binding in attempters vs. nonattempters may suggest a biological risk marker. Localized lower 5-HTT and widespread higher 5-HT1A binding with stress among attempters specifically may suggest that a serotonergic phenotype might be a key determinant of risk or resiliency for suicidal behavior.
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Affiliation(s)
- Elizabeth A Bartlett
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA.
| | - Francesca Zanderigo
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Barbara Stanley
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Tse-Hwei Choo
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Hanga C Galfalvy
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Spiro P Pantazatos
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - J John Mann
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, USA; Department of Psychiatry, Columbia University Irving Medical Center, New York, USA; Department of Radiology, Columbia University Irving Medical Center, New York, USA
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8
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Melhem N, Moutier CY, Brent DA. Implementing Evidence-Based Suicide Prevention Strategies for Greatest Impact. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:117-128. [PMID: 37201145 PMCID: PMC10172552 DOI: 10.1176/appi.focus.20220078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Suicide remains a leading cause of death in the United States and globally. In this review, epidemiological trends in mortality and suicide risk are presented, with consideration given to the impact of the COVID-19 pandemic. A public health model of suicide prevention with a community and clinical framework, along with advances in scientific discovery, offer new solutions that await widespread implementation. Actionable interventions with evidence for reducing risk for suicidal behavior are presented, including universal and targeted strategies at community, public policy, and clinical levels. Clinical interventions include screening and risk assessment; brief interventions (e.g., safety planning, education, and lethal means counseling) that can be done in primary care, emergency, and behavioral health settings; psychotherapies (cognitive-behavioral, dialectical behavior, mentalization therapy); pharmacotherapy; and systemwide procedures for health care organizations (training, policies, workflow, surveillance of suicide indicators, use of health records for screening, care steps). Suicide prevention strategies must be prioritized and implemented at scale for greatest impact.
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Affiliation(s)
- Nadine Melhem
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
| | - Christine Yu Moutier
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
| | - David A Brent
- Department of Psychiatry (Melhem), Department of Clinical and Translational Science (Melhem, Brent), and Departments of Pediatric Psychiatry, Epidemiology, and Suicide Studies (Brent), University of Pittsburgh, Pittsburgh; American Foundation for Suicide Prevention, New York (Moutier)
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9
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The associations between suicide-related behaviors, prefrontal dysfunction in emotional cognition, and personality traits in mood disorders. Sci Rep 2022; 12:17377. [PMID: 36253452 PMCID: PMC9576702 DOI: 10.1038/s41598-022-22345-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/13/2022] [Indexed: 01/10/2023] Open
Abstract
Suicide is a serious public health problem, and it is urgent to identify biomarkers associated with suicide to prevent it. We aimed to clarify the association across suicidal behavior, personality traits, and brain activation by emotional stimulation tasks using near-infrared spectroscopy (NIRS) in patients with mood disorders. 11 mood disorder patients with a history of suicide attempt (MDSA), 18 mood disorder patients with no history of suicide attempt (MDNSA), and 17 healthy individuals were studied. The MDSA patients showed significantly high impulsivity and hopeless compared to healthy subjects, great response to the thread word task in the orbitofrontal cortex (OFC) and dorsolateral prefrontal cortex (DLPFC) compared to MDNSA patients, and the significant correlation between the personality traits and brain activation. The MDNSA did not show the trend. The results suggest that the personality traits and the activation of OFC and DLPFC during the negative emotional cognitive stimuli is associated with suicidal behavior, indicating the findings are involved in the pathophysiology of suicidality in mood disorders.
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10
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Popova NK, Tsybko AS, Naumenko VS. The Implication of 5-HT Receptor Family Members in Aggression, Depression and Suicide: Similarity and Difference. Int J Mol Sci 2022; 23:ijms23158814. [PMID: 35955946 PMCID: PMC9369404 DOI: 10.3390/ijms23158814] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/21/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
Being different multifactorial forms of psychopathology, aggression, depression and suicidal behavior, which is considered to be violent aggression directed against the self, have principal neurobiological links: preclinical and clinical evidence associates depression, aggression and suicidal behavior with dysregulation in central serotonergic (5-HT) neurotransmission. The implication of different types of 5-HT receptors in the genetic and epigenetic mechanisms of aggression, depression and suicidality has been well recognized. In this review, we consider and compare the orchestra of 5-HT receptors involved in these severe psychopathologies. Specifically, it concentrates on the role of 5-HT1A, 5-HT1B, 5-HT2A, 5-HT2B, 5-HT2C, 5-HT3 and 5-HT7 receptors in the mechanisms underlying the predisposition to aggression, depression and suicidal behavior. The review provides converging lines of evidence that: (1) depression-related 5-HT receptors include those receptors with pro-depressive properties (5-HT2A, 5-HT3 and 5-HT7) as well as those providing an antidepressant effect (5-HT1A, 5-HT1B, 5-HT2C subtypes). (2) Aggression-related 5-HT receptors are identical to depression-related 5-HT receptors with the exception of 5-HT7 receptors. Activation of 5-HT1A, 5-HT1B, 5-HT2A, 5-HT2C receptors attenuate aggressiveness, whereas agonists of 5-HT3 intensify aggressive behavior.
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11
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Bartlett EA, Zanderigo F, Shieh D, Miller J, Hurley P, Rubin-Falcone H, Oquendo MA, Sublette ME, Ogden RT, Mann JJ. Serotonin transporter binding in major depressive disorder: impact of serotonin system anatomy. Mol Psychiatry 2022; 27:3417-3424. [PMID: 35487966 PMCID: PMC9616969 DOI: 10.1038/s41380-022-01578-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
Serotonin transporter (5-HTT) binding deficits are reported in major depressive disorder (MDD). However, most studies have not considered serotonin system anatomy when parcellating brain regions of interest (ROIs). We now investigate 5-HTT binding in MDD in two novel ways: (1) use of a 5-HTT tract-based analysis examining binding along serotonergic axons; and (2) using the Copenhagen University Hospital Neurobiology Research Unit (NRU) 5-HT Atlas, based on brain-wide binding patterns of multiple serotonin receptor types. [11C]DASB 5-HTT PET scans were obtained in 60 unmedicated participants with MDD in a current depressive episode and 31 healthy volunteers (HVs). Binding potential (BPP) was quantified with empirical Bayesian estimation in graphical analysis (EBEGA). Within the [11C]DASB tract, the MDD group showed significantly lower BPP compared with HVs (p = 0.02). This BPP diagnosis difference also significantly varied by tract location (p = 0.02), with the strongest MDD binding deficit most proximal to brainstem raphe nuclei. NRU 5-HT Atlas ROIs showed a BPP diagnosis difference that varied by region (p < 0.001). BPP was lower in MDD in 3/10 regions (p-values < 0.05). Neither [11C]DASB tract or NRU 5-HT Atlas BPP correlated with depression severity, suicidal ideation, suicide attempt history, or antidepressant medication exposure. Future studies are needed to determine the causes of this deficit in 5-HTT binding being more pronounced in proximal axon segments and in only a subset of ROIs for the pathogenesis of MDD. Such regional specificity may have implications for targeting antidepressant treatment, and may extend to other serotonin-related disorders.
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Affiliation(s)
- Elizabeth A Bartlett
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA.
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA.
| | - Francesca Zanderigo
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Denise Shieh
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey Miller
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Patrick Hurley
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Harry Rubin-Falcone
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - R Todd Ogden
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - J John Mann
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
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12
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Maruani J, Geoffroy PA. Multi-Level Processes and Retina-Brain Pathways of Photic Regulation of Mood. J Clin Med 2022; 11:jcm11020448. [PMID: 35054142 PMCID: PMC8781294 DOI: 10.3390/jcm11020448] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 02/06/2023] Open
Abstract
Light exerts powerful biological effects on mood regulation. Whereas the source of photic information affecting mood is well established at least via intrinsically photosensitive retinal ganglion cells (ipRGCs) secreting the melanopsin photopigment, the precise circuits that mediate the impact of light on depressive behaviors are not well understood. This review proposes two distinct retina–brain pathways of light effects on mood: (i) a suprachiasmatic nucleus (SCN)-dependent pathway with light effect on mood via the synchronization of biological rhythms, and (ii) a SCN-independent pathway with light effects on mood through modulation of the homeostatic process of sleep, alertness and emotion regulation: (1) light directly inhibits brain areas promoting sleep such as the ventrolateral preoptic nucleus (VLPO), and activates numerous brain areas involved in alertness such as, monoaminergic areas, thalamic regions and hypothalamic regions including orexin areas; (2) moreover, light seems to modulate mood through orexin-, serotonin- and dopamine-dependent pathways; (3) in addition, light activates brain emotional processing areas including the amygdala, the nucleus accumbens, the perihabenular nucleus, the left hippocampus and pathways such as the retina–ventral lateral geniculate nucleus and intergeniculate leaflet–lateral habenula pathway. This work synthetizes new insights into the neural basis required for light influence mood
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Affiliation(s)
- Julia Maruani
- Département de Psychiatrie et d’Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat—Claude Bernard, F-75018 Paris, France
- NeuroDiderot, INSERM U1141, Université de Paris, F-75019 Paris, France
- Correspondence: (J.M.); (P.A.G.); Tel.: +33-(0)1-40-25-82-62 (J.M. & P.A.G.)
| | - Pierre A. Geoffroy
- Département de Psychiatrie et d’Addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat—Claude Bernard, F-75018 Paris, France
- NeuroDiderot, INSERM U1141, Université de Paris, F-75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 5 rue Blaise Pascal, F-67000 Strasbourg, France
- GHU Paris—Psychiatry & Neurosciences, 1 Rue Cabanis, F-75014 Paris, France
- Correspondence: (J.M.); (P.A.G.); Tel.: +33-(0)1-40-25-82-62 (J.M. & P.A.G.)
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13
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Poblete G, Nguyen T, Gosnell S, Sofela O, Patriquin M, Mathew SJ, Swann A, Nielsen DA, Kosten TR, Salas R. A Novel Approach to Link Genetics and Human MRI Identifies AKAP7-Dependent Subicular/Prefrontal Functional Connectivity as Altered in Suicidality. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2022; 6:24705470221083700. [PMID: 35340866 PMCID: PMC8941704 DOI: 10.1177/24705470221083700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/10/2022] [Indexed: 11/21/2022]
Abstract
Background Brain imaging and genetics are fields acquiring data at increasing speed, but more information does not always result in a better understanding of the underlying biology. We developed the ProcessGeneLists (PGL) approach to use genetics and mRNA gene expression data to generate regions of interest for imaging studies. Methods We applied PGL to past suicide attempt (ATT): We averaged the mRNA expression levels of genes (n = 130) possibly associated with ATT (p ≤ 10-3 in a published genome-wide association study, GWAS) in each brain region studied in the Human Allen Brain Atlas (6 ex-vivo brains, 158 to 946 regions/brain have mRNA expression data) and compared that to the averaged mRNA expression levels of all other genes in each region in each brain in the atlas. Results PGL revealed 8 regions where "attempt-related genes" were differentially expressed (Wilcoxon test with Bonferroni correction 8.88-11 = Conclusion PGL uncovered a brain function/genotype interaction in ATT by using published GWAS data to inform imaging studies. This could inform individualized therapies in the future.
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Affiliation(s)
- Guillermo Poblete
- The Menninger Clinic, Houston, TX, USA
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Savannah Gosnell
- Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | | | - Michelle Patriquin
- The Menninger Clinic, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
| | - Sanjay J. Mathew
- The Menninger Clinic, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical
Center, Houston, TX, USA
| | - Alan Swann
- Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical
Center, Houston, TX, USA
| | - David A. Nielsen
- Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical
Center, Houston, TX, USA
| | - Thomas R. Kosten
- Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical
Center, Houston, TX, USA
| | - Ramiro Salas
- The Menninger Clinic, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine, Houston, TX, USA
- Michael E DeBakey VA Medical
Center, Houston, TX, USA
- Center for Translational Research on Inflammatory Diseases, Michael E DeBakey VA Medical
Center, Houston, TX, USA
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14
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Ho TC, Gifuni AJ, Gotlib IH. Psychobiological risk factors for suicidal thoughts and behaviors in adolescence: a consideration of the role of puberty. Mol Psychiatry 2022; 27:606-623. [PMID: 34117365 PMCID: PMC8960417 DOI: 10.1038/s41380-021-01171-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 02/05/2023]
Abstract
Suicide is the second leading cause of death among adolescents. While clinicians and researchers have begun to recognize the importance of considering multidimensional factors in understanding risk for suicidal thoughts and behaviors (STBs) during this developmental period, the role of puberty has been largely ignored. In this review, we contend that the hormonal events that occur during puberty have significant effects on the organization and development of brain systems implicated in the regulation of social stressors, including amygdala, hippocampus, striatum, medial prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex. Guided by previous experimental work in adults, we also propose that the influence of pubertal hormones and social stressors on neural systems related to risk for STBs is especially critical to consider in adolescents with a neurobiological sensitivity to hormonal changes. Furthermore, facets of the pubertal transition, such as pubertal timing, warrant deeper investigation and may help us gain a more comprehensive understanding of sex differences in the neurobiological and psychosocial mechanisms underlying adolescent STBs. Ultimately, advancing our understanding of the pubertal processes that contribute to suicide risk will improve early detection and facilitate the development of more effective, sex-specific, psychiatric interventions for adolescents.
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Affiliation(s)
- Tiffany C. Ho
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, CA USA ,grid.266102.10000 0001 2297 6811Department of Psychiatry and Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA USA
| | - Anthony J. Gifuni
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, CA USA ,grid.14709.3b0000 0004 1936 8649Psychiatry Department and Douglas Mental Health University Institute, McGill University, Montréal, QC Canada
| | - Ian H. Gotlib
- grid.168010.e0000000419368956Department of Psychology, Stanford University, Stanford, CA USA
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15
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Mann JJ. Can Knowledge of Genetic and Environmental Causal Factors of Fatal and Nonfatal Suicidal Behavior Be Translated Into Better Prevention? Am J Psychiatry 2021; 178:994-997. [PMID: 34734746 DOI: 10.1176/appi.ajp.2021.21090913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J John Mann
- Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, andDepartment of Psychiatry, Columbia University, New York
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16
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Melhem NM, Zhong Y, Miller JM, Zanderigo F, Ogden RT, Sublette ME, Newell M, Burke A, Keilp JG, Lesanpezeshki M, Bartlett E, Brent DA, Mann JJ. Brain 5-HT1A Receptor PET Binding, Cortisol Responses to Stress, and the Familial Transmission of Suicidal Behavior. Int J Neuropsychopharmacol 2021; 25:36-45. [PMID: 34555145 PMCID: PMC8756092 DOI: 10.1093/ijnp/pyab060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/22/2021] [Accepted: 10/04/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The serotonin 1A (5-HT1A) receptor has been implicated in depression and suicidal behavior. Lower resting cortisol levels are associated with higher 5-HT1A receptor binding, and both differentiate suicide attempters with depression. However, it is not clear whether 5-HT1A receptor binding and cortisol responses to stress are related to familial risk and resilience for suicidal behavior. METHODS [11C]CUMI-101 positron emission tomography imaging to quantify regional brain 5-HT1A receptor binding was conducted in individuals considered to be at high risk for mood disorder or suicidal behavior on the basis of having a first- or second-degree relative(s) with an early onset mood disorder and history of suicidal behavior. These high-risk individuals were subdivided into the following groups: high risk resilient having no mood disorder or suicidal behavior (n = 29); high risk with mood disorder and no suicidal behavior history (n = 31); and high risk with mood disorder and suicidal behavior (n = 25). Groups were compared with healthy volunteers without a family history of mood disorder or suicidal behavior (n = 34). Participants underwent the Trier Social Stress Task (TSST). All participants were free from psychotropic medications at the time of the TSST and PET scanning. RESULTS We observed no group differences in 5-HT1A receptor binding considering all regions simultaneously, nor did we observe heterogeneity of the effect of group across regions. These results were similar across outcome measures (BPND for all participants and BPp in a subset of the sample) and definitions of regions of interest (ROIs; standard or serotonin system-specific ROIs). We also found no group differences on TSST outcomes. Within the high risk with mood disorder and suicidal behavior group, lower BPp binding (β = -0.084, SE = 0.038, P = .048) and higher cortisol reactivity to stress (β = 9.25, 95% CI [3.27,15.23], P = .004) were associated with higher lethality attempts. There were no significant relationships between 5-HT1A binding and cortisol outcomes. CONCLUSIONS 5-HT1A receptor binding in ROIs was not linked to familial risk or resilience protecting against suicidal behavior or mood disorder although it may be related to lethality of suicide attempt. Future studies are needed to better understand the biological mechanisms implicated in familial risk for suicidal behavior and how hypothalamic-pituitary-adrenal axis function influences such risk.
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Affiliation(s)
- Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Correspondence: Nadine Melhem, PhD, 3811 O’Hara Street, Pittsburgh, PA 15213, USA ()
| | - Yongqi Zhong
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Graduate School of Public Health, University of Pittsburgh
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Francesca Zanderigo
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - R Todd Ogden
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Madison Newell
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
| | - Ainsley Burke
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - John G Keilp
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Mohammad Lesanpezeshki
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - Elizabeth Bartlett
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
| | - David A Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - J John Mann
- Molecular Imaging and Neuropathology Area, New York State Psychiatric Institute, New York, New York, United States
- Department of Psychiatry, Columbia University, New York, New York, United States
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17
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Goldstein KE, Feinberg A, Corniquel MB, Szeszko JR, New AS, Haznedar MM, Goodman M, Chu KW, Tang CY, Hazlett EA. Anomalous Amygdala Habituation to Unpleasant Stimuli Among Unmedicated Individuals With Borderline Personality Disorder and a History of Self-Harming Behavior. J Pers Disord 2021; 35:618-631. [PMID: 33779281 DOI: 10.1521/pedi_2020_34_495] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Self-harming behavior (SB) is one of the diagnostic criteria for borderline personality disorder (BPD). However, it is not exhibited by all individuals with BPD. Furthermore, studies examining the neural correlates of SB in BPD are lacking. Given research showing that BPD patients have difficulty habituating to affective stimuli, this study investigated whether anomalous amygdala activation is specific to BPD patients with SB. The authors used fMRI to compare amygdala activation in BPD patients with SB (n = 15) to BPD patients without SB (n = 18) and healthy controls (n = 32) during a task involving pleasant, neutral, and unpleasant pictures, presented twice. BPD patients with SB demonstrated greater amygdala activity during the second presentation of unpleasant pictures. Results highlight neurobiological differences in BPD patients with and without SB and suggest that anomalous amygdala habituation to unpleasant stimuli may be related to SB.
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Affiliation(s)
- Kim E Goldstein
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Abigail Feinberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Morgan B Corniquel
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jake R Szeszko
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Mehmet Haznedar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Health Patient Care Center, James J. Peters Veterans Affairs Medical Center
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - King-Wai Chu
- Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
| | - Cheuk Y Tang
- Translational and Molecular Imaging Institute, Department of Radiology, Icahn School of Medicine at Mount Sinai
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Mental Illness Research, Education, and Clinical Center (MIRECC VISN 2), James J. Peters VA Medical Center, Bronx, New York
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18
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Affiliation(s)
- J John Mann
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York (Mann, Rizk); Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York (Mann, Rizk); Department of Radiology, Columbia University Irving Medical Center, New York (Mann)
| | - Mina M Rizk
- Department of Psychiatry, Columbia University Irving Medical Center, Columbia University, New York (Mann, Rizk); Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York (Mann, Rizk); Department of Radiology, Columbia University Irving Medical Center, New York (Mann)
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Vargas-Medrano J, Diaz-Pacheco V, Castaneda C, Miranda-Arango M, Longhurst MO, Martin SL, Ghumman U, Mangadu T, Chheda S, Thompson PM, Gadad BS. Psychological and neurobiological aspects of suicide in adolescents: Current outlooks. Brain Behav Immun Health 2020; 7:100124. [PMID: 32835300 PMCID: PMC7405877 DOI: 10.1016/j.bbih.2020.100124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/10/2023] Open
Abstract
Suicidality is one of the leading causes of death among young adults in the United States and represents a significant health problem worldwide. The suicide rate among adolescents in the United States has increased dramatically in the latest years and has been accompanied by considerable changes in youth suicide, especially among young girls. Henceforth, we need a good understanding of the risk factors contributing to suicidal behavior in youth. An explanatory model for suicidal behavior that links clinical and psychological risk factors to the underlying neurobiological, neuropsychological abnormalities related to suicidal behavior might predict to help identify treatment options and have empirical value. Our explanatory model proposes that developmental, biological factors (genetics, proteomics, epigenetics, immunological) and psychological or clinical (childhood adversities) may have causal relevance to the changes associated with suicidal behavior. In this way, our model integrates findings from several perspectives in suicidality and attempts to explain the relationship between various neurobiological, genetic, and clinical observations in suicide research, offering a comprehensive hypothesis to facilitate understanding of this complex outcome. Unraveling the knowledge of the complex interplay of psychological, biological, sociobiological, and clinical risk factors is highly essential, concerning the development of effective prevention strategy plans for suicidal ideation and suicide.
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Affiliation(s)
- Javier Vargas-Medrano
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Valeria Diaz-Pacheco
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Christopher Castaneda
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Manuel Miranda-Arango
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, TX, 79968, USA
| | - Melanie O Longhurst
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Sarah L. Martin
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Usman Ghumman
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Thenral Mangadu
- Minority AIDS Research Center, Department of Health Sciences, The University of Texas at El Paso, TX, 79968, USA
| | - Sadhana Chheda
- Department of Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
| | - Peter M. Thompson
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
| | - Bharathi S. Gadad
- Department of Psychiatry, Paul L. Foster School of Medicine, Texas Tech University Health Science Center, El Paso, TX, 79905, USA
- Southwest Brain Bank, Texas Tech University Health Science Center, El Paso, TX, 79905, University of Texas, El Paso, USA
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20
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Hu J, Wen Y, Duan Y, Yan S, Liao Y, Pan H, Zhu J, Yin P, Cheng J, Jiang H. The impact of extreme heat and heat waves on emergency ambulance dispatches due to external cause in Shenzhen, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 261:114156. [PMID: 32092626 DOI: 10.1016/j.envpol.2020.114156] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Compared to hospital admissions (HAs), emergency ambulance dispatches (EADs) can be considered a real-time outcome for evaluating the public health impacts of ambient temperature. OBJECTIVES This study aimed to assess if temperature has a causal effect on cause-specific EADs and its potential main and added effect in Shenzhen from 2013 to 2017. METHODS A distributed lag nonlinear model (DLNM) with quasi-Poisson distribution was applied to quantify the association between temperature and EADs. Likewise, the fraction of EADs attributable to different temperature ranges was calculated to identify extreme temperature ranges affecting population health. We then explored the main and added wave effects of heatwaves. RESULTS Ambient temperature showed a U-shaped association with EADs. The minimum risk temperature was 17 °C (16th percentile of the daily mean temperature). Compared with the cold, the relative risk (RR) of heat on EADs presented smaller but the attributable risk larger. The main effects of heatwaves on EADs varied with external causes; and the peak RR of heat on EADs was observed in suicidal behaviors with heatwaves defined as 3 or more days with temperatures above the 75th percentile (RR = 4.53, 95% CI: 1.23-16.68), followed by assault (RR = 2.36, 95% CI: 1.25-4.48) and accidents (RR = 1.72, 95% CI: 1.30-2.28), while the added wave effect was negligible. CONCLUSIONS Heat was responsible for a higher proportion of EADs than cold. Most of the increase in health risk during warm season can be simply ascribed to the independent effects of daily temperature occurrences whether it is or not on the heat-wave day. And the main effects of heatwaves on cause-specific EADs showed varied change trends, of which the incidence of suicides seems more susceptible, followed by assault and accidents.
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Affiliation(s)
- Jing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Wen
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Siyu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Liao
- Department of Public Health Promotion, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Haibin Pan
- Laboratory of Physical Testing and Chemical Analysis, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jiahui Zhu
- Department of Molecular Epidemiology, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinquan Cheng
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hongwei Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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21
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Steinberg LJ, Mann JJ. Abnormal stress responsiveness and suicidal behavior: A risk phenotype. Biomark Neuropsychiatry 2020. [DOI: 10.1016/j.bionps.2020.100011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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22
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Choi KW, Kwon S, Pyun SB, Tae WS. Shape Deformation in the Brainstem of Medication-Naïve Female Patients with Major Depressive Disorder. Psychiatry Investig 2020; 17:465-474. [PMID: 32403210 PMCID: PMC7265019 DOI: 10.30773/pi.2020.0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/09/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although neuroimaging studies have shown volumetric reductions, such as the anterior cingulate, prefrontal cortices, and hippocampus in patients with major depressive disorder (MDD), few studies have investigated the volume of or shape alterations in the subcortical regions and the brainstem. We hypothesized that medication-naïve female adult patients with MDD might present with shape and volume alterations in the subcortical regions, including the brainstem, compared to healthy controls (HCs). METHODS A total of 20 medication-naïve female patients with MDD and 21 age-matched female HCs, underwent 3D T1-weighted structural magnetic resonance scanning. We analyzed the volumes of each subcortical region and each brainstem region, including the midbrain, pons, and medulla oblongata. We also performed surface-based vertex analyses on the subcortical areas and brainstem. RESULTS Female patients with MDD showed non-significant volumetric differences in the subcortical regions, whole brainstem, and each brainstem region compared to the HCs. However, in the surface-based vertex analyses, significant shape contractions were observed in both cerebellar peduncles located on the lateral wall of the posterior brainstem [threshold-free cluster enhancement, corrected for family-wise error (FWE) at p<0.05] in patients with MDD. CONCLUSION We revealed shape alterations in the posterior brainstem in female patients with MDD.
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Affiliation(s)
- Kwan Woo Choi
- Department of Psychiatry, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soonwook Kwon
- Department of Anatomy, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea.,Brain Convergence Research Center, Korea University, Seoul, Republic of Korea
| | - Woo-Suk Tae
- Brain Convergence Research Center, Korea University, Seoul, Republic of Korea
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23
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Ryan EP, Oquendo MA. Suicide Risk Assessment and Prevention: Challenges and Opportunities. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:88-99. [PMID: 33162846 DOI: 10.1176/appi.focus.20200011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite increased access to mental health care for the previously uninsured and expanding evidence-based treatments for mood, anxiety, psychotic, and substance use disorders, suicide is on the rise in the United States. Since 1999, the age-adjusted suicide rate in the United States has increased 33%, from 10.5 per 100,000 standard population to 14.0. As of yet, there are no clinically available biomarkers, laboratory tests, or imaging to assist in diagnosis or the identification of the suicidal individual. Suicide risk assessment remains a high-stakes component of the psychiatric evaluation and can lead to overly restrictive management in the name of prevention or to inadequate intervention because of poor appreciation of the severity of risk. This article focuses primarily on suicide risk assessment and management as a critical first step to prevention, given the fact that more research is needed to identify precision treatments and effective suicide prevention strategies. Suicide risk assessment provides the clinical psychiatrist with an opportunity for therapeutic engagement with the ultimate goals of relieving suffering and preventing suicide.
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Affiliation(s)
- Eileen P Ryan
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus (Ryan); and Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oquendo)
| | - Maria A Oquendo
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus (Ryan); and Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oquendo)
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24
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Yin H, Galfalvy H, Zhang B, Tang W, Xin Q, Li E, Xue X, Li Q, Ye J, Yan N, Mann JJ. Interactions of the GABRG2 polymorphisms and childhood trauma on suicide attempt and related traits in depressed patients. J Affect Disord 2020; 266:447-455. [PMID: 32056912 DOI: 10.1016/j.jad.2020.01.126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/28/2019] [Accepted: 01/20/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previously, we reported that the longest variant of the GABA A receptor γ2 subunit (GABRG2) was associated with suicidal behavior. The present study therefore aimed to determine whether polymorphisms near the alternatively spliced exon of GABRG2 are associated with suicide attempt (SA) and its related traits, and how these variants might interact with reported childhood trauma (CT) in their association with suicidal behavior. METHODS We examined 5 single nucleotide polymorphisms (SNPs) of GABRG2. Subjects were suicide Attempters (N = 94), non-suicide attempters (N = 168) with MDD or Bipolar depression, and healthy volunteers (N = 100). Data on demographics, depression severity and suicide attempts were collected. Participants also completed a set of instruments assessing CT, and lifetime aggression and impulsivity.. GABRG2 polymorphisms were genotyped using Sanger sequencing. RESULTS Allele A of rs211034 was a protective factor for SA (OR = 0.50 (0.32, 0.80), p = 0.003), and had an interaction effect with emotional neglect (OR = 0.89 (0.82, 0.97), p = 0.006) on depression. One haploblock (consisting of rs211035 and rs211034) was identified within these SNPs, and subjects with haplotype GA (frequency = 7.3%), had lower rate of SA (OR=0.26(0.10, 0.67), p = 0.006). Cognitive impulsivity (OR=1.38)1.24,1.55), p < 0.001), non-planning impulsivity (OR = 1.18 (1.10,1.25), p < 0.001), anger (OR = 1.13 (1.07,1.19), p < 0.001), impulsivity total score (OR = 1.10(1.06,1.15), p < 0.001), hostility (OR = 1.10 (1.04, 1.15), p < 0.001), aggression total score (OR = 1.05 (1.03,1.07), p < 0.001) were associated with depression, meanwhile, hopelessness (OR = 2.18 (1.56, 3.04), p < 0.001) and impulsivity total score (OR = 1.05 (1.02,1.08), p < 0.001) were associated with the risk of SA, adjusted by age and gender. There was no mediation effect in the relationship among CT, gene polymorphisms and SA or depression through increased impulsivity or aggression. LIMITATIONS The main limitation of this study is its modest sample size. More genetic variants as well as epigenetic markers should be examined in future studies. CONCLUSIONS These findings add to evidence for the involvement of GABRG2 and impulsivity and hopelessness in SA independent from their association with depression. More research is needed on possible mediators of the relationship between GABA-related gene and SA.
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Affiliation(s)
- Honglei Yin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China.
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University, New York, NY
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Weiwei Tang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Qianqian Xin
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Enze Li
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Xiang Xue
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Qiyang Li
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Junping Ye
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - Na Yan
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, China
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY; Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, New York.
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25
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Gilbert JR, Ballard ED, Galiano CS, Nugent AC, Zarate CA. Magnetoencephalographic Correlates of Suicidal Ideation in Major Depression. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:354-363. [PMID: 31928949 PMCID: PMC7064429 DOI: 10.1016/j.bpsc.2019.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/07/2019] [Accepted: 11/22/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Defining the neurobiological underpinnings of suicidal ideation (SI) is crucial to improving our understanding of suicide. This study used magnetoencephalographic gamma power as a surrogate marker for population-level excitation-inhibition balance to explore the underlying neurobiology of SI and depression. In addition, effects of pharmacological intervention with ketamine, which has been shown to rapidly reduce SI and depression, were assessed. METHODS Data were obtained from 29 drug-free patients with major depressive disorder who participated in an experiment comparing subanesthetic ketamine (0.5 mg/kg) with a placebo saline infusion. Magnetoencephalographic recordings were collected at baseline and after ketamine and placebo infusions. During scanning, patients rested with their eyes closed. SI and depression were assessed, and a linear mixed-effects model was used to identify brain regions where gamma power and both SI and depression were associated. Two regions of the salience network (anterior insula, anterior cingulate) were then probed using dynamic causal modeling to test for ketamine effects. RESULTS Clinically, patients showed significantly reduced SI and depression after ketamine administration. In addition, distinct regions in the anterior insula were found to be associated with SI compared with depression. In modeling of insula-anterior cingulate connectivity, ketamine lowered the membrane capacitance for superficial pyramidal cells. Finally, connectivity between the insula and anterior cingulate was associated with improvements in depression symptoms. CONCLUSIONS These findings suggest that the anterior insula plays a key role in SI, perhaps via its role in salience detection. In addition, transient changes in superficial pyramidal cell membrane capacitance and subsequent increases in cortical excitability might be a mechanism through which ketamine improves SI.
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Affiliation(s)
- Jessica R Gilbert
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland.
| | - Elizabeth D Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Christina S Galiano
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Allison C Nugent
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
| | - Carlos A Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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26
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Schmaal L, van Harmelen AL, Chatzi V, Lippard ETC, Toenders YJ, Averill LA, Mazure CM, Blumberg HP. Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Mol Psychiatry 2020; 25:408-427. [PMID: 31787757 PMCID: PMC6974434 DOI: 10.1038/s41380-019-0587-x] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 01/06/2023]
Abstract
Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.
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Affiliation(s)
- Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Vasiliki Chatzi
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Yara J Toenders
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lynnette A Averill
- Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, West Haven, CT, USA
| | - Carolyn M Mazure
- Psychiatry and Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
| | - Hilary P Blumberg
- Psychiatry, Radiology and Biomedical Imaging, Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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27
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Alarcón RD, Lolas F, Mari JJ, Lázaro J, Baca-Baldomero E. Latin American and Spanish-speaking perspectives on the challenges of global psychiatry. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:77-86. [PMID: 31269096 PMCID: PMC6986483 DOI: 10.1590/1516-4446-2018-0397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/25/2019] [Indexed: 01/22/2023]
Abstract
The multi-faceted phenomenon known as globalization has a particular impact on the conceptual and practical development of mental health disciplines in general, and psychiatry in particular, across different world regions. To be theoretically and functionally effective, global psychiatry requires an integration of its different components. To such objective, and after a brief review of continental European and Anglo-Saxon contributions, this article examines the history, characteristics, and contributions of Latin/Iberian American and Spanish-speaking psychiatry, in order to substantiate its role in world psychiatry. The Latin American proper (including Portuguese-speaking Brazil), Spain, and U.S.-based Hispanic components are described, revealing an identity that is based on a humanistic tradition, a value-based, culturally-determined clinical approach to patient care, and a pragmatic adaptation of different treatment resources and techniques. These may constitute supportive elements of an instrumental inter-regional bond in the present and future of our discipline.
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Affiliation(s)
- Renato D. Alarcón
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Universidad Peruana Cayetano Heredia, Lima, Peru
- World Association of Cultural Psychiatry
| | - Fernando Lolas
- Departamento de Psiquiatría y Centro Interdisciplinario de Estudios en Bioética, Universidad de Chile, Santiago, Chile
- World Association for Social Psychiatry
| | - Jair J. Mari
- Departamento de Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - José Lázaro
- Departamento de Psiquiatría, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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28
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Lengvenyte A, Conejero I, Courtet P, Olié E. Biological bases of suicidal behaviours: A narrative review. Eur J Neurosci 2019; 53:330-351. [PMID: 31793103 DOI: 10.1111/ejn.14635] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/05/2019] [Accepted: 11/28/2019] [Indexed: 12/13/2022]
Abstract
Suicidal behaviour is a multifaceted phenomenon that concerns all human populations. It has been suggested that a complex interaction between the individual genetic profile and environmental factors throughout life underlies the pathophysiology of suicidal behaviour. Although epidemiological and genetic studies suggest the existence of a genetic component, exposure to biological and psychosocial adversities, especially during critical developmental periods, also contributes to altering the biological responses to threat and pleasure. This results in amplified maladaptive cognitive and behavioural traits and states associated with suicidal behaviours. Alterations in the cognitive inhibition and decision-making capacity have been implicated in suicidal behaviours. Structural and functional changes in key brain regions and networks, such as prefrontal cortex, insula and default mode network, may underlie this relationship. Furthermore, the shift from health to suicidal behaviour incorporates complex and dynamic changes in the immune and stress responses, monoaminergic system, gonadal system and neuroplasticity. In this review, we describe the major findings of epidemiological, genetic, neuroanatomical, neuropsychological, immunological and neuroendocrinological studies on suicide behaviours to provide a solid background for future research in this field. This broad overview of the biological bases of suicide should promote neuroscience research on suicidal behaviours. This might lead to improved biological models and to the identification of evidence-based biomarkers, treatment options and preventive strategies.
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Affiliation(s)
- Aiste Lengvenyte
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania
| | - Ismael Conejero
- Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France.,Department of Psychiatry, CHU Nimes, University of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
| | - Emilie Olié
- Department of Emergency Psychiatry & Acute Care, CHU Montpellier, University of Montpellier, Montpellier, France.,Neuropsychiatry: Epidemiological and Clinical Research, Inserm Unit 1061, Montpellier, France
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Lee H, Jung J, Myung W, Baek JH, Kang JM, Kim DK, Kim H. Association between dust storm occurrence and risk of suicide: Case-crossover analysis of the Korean national death database. ENVIRONMENT INTERNATIONAL 2019; 133:105146. [PMID: 31630066 DOI: 10.1016/j.envint.2019.105146] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Asian dust storms (ADSs) have been associated with adverse health outcomes, including respiratory and cardiovascular diseases. Considering the increasing global desertification driven by climate change, it is necessary to assess dust storm-related adverse health effects for establishing appropriate public health interventions. Recent studies have found that ambient air pollution has negative effects on mental health including cognitive disorders, depression, and suicide. However, these studies mostly focused on traditional anthropogenic pollutants from traffic exhaust or fossil fuel power plants; the association between dust storms and suicidal death is yet to be determined. OBJECTIVE To assess the association between ADSs and suicide risk in Seoul, South Korea from 2002 to 2015. METHODS To determine whether increased risk of suicide is associated with occurrence of ADSs, we performed a time-stratified case-crossover study that linked the national death statistics database with ADS occurrence data from the Korea Meteorology Administration. Exposure to ADSs was compared between the day of suicide and control days, matched to the day of the week, month, and year. We further examined whether the effect of ADSs on suicide risk differed according to ADS duration and intensity. RESULTS Over the 14-year period, 30,704 people died by suicide and 133 ADSs were reported. Of these, 55 ADSs lasted over 2 days (long-duration ADSs), and 67 ADSs had higher levels of particulate matter < 10 μm in diameter (PM10) that exceeded the 50th percentile value over the total 133 ADS days (high-intensity ADSs). Exposure to ADS was associated with a 13.1% (95% confidence interval [CI], 4.5-22.4; P = .002) increase in suicide risk on the day of ADS occurrence. Long-duration and high-intensity ADSs were associated with a 19.8% (95% CI, 6.5-34.7; P = .003) and 17.0% (95% CI, 5.2-30.0; P = .004) increase in suicide risk, respectively. These associations remained robust after adjusting for local air pollution levels and meteorological factors. However, this association was not replicated in the unconstrained distributed lag model which revealed inferior goodness-of-fit to our data. CONCLUSIONS Exposure to ADSs was associated with an increased risk of suicide, especially on the same day. This study provides novel evidence of a relationship between ADSs and suicide. These findings could help in establishing public health interventions for suicide prevention as well as in establishing dust storm warning systems. Future studies are warranted to confirm if our findings are replicable and to elucidate the underlying mechanisms.
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Affiliation(s)
- Hyewon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea; Institute of Health and Environment, Seoul National University, South Korea
| | - Jiyun Jung
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, South Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Ji Hyun Baek
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho Kim
- Institute of Health and Environment, Seoul National University, South Korea; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, South Korea.
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Gopaldas M, Zanderigo F, Zhan S, Ogden RT, Miller JM, Rubin-Falcone H, Cooper TB, Oquendo MA, Sullivan G, Mann JJ, Sublette ME. Brain serotonin transporter binding, plasma arachidonic acid and depression severity: A positron emission tomography study of major depression. J Affect Disord 2019; 257:495-503. [PMID: 31319341 PMCID: PMC6886679 DOI: 10.1016/j.jad.2019.07.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/11/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Serotonin transporter (5-HTT) binding and polyunsaturated fatty acids (PUFAs) are implicated in major depressive disorder (MDD). Links between the two systems in animal models have not been investigated in humans. METHODS Using positron emission tomography (PET) and [11C]DASB, we studied relationships between 5-HTT binding potential and plasma levels of PUFAs docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (AA) in medication-free MDD patients (n = 21). PUFAs were quantified using transesterification and gas chromatography. Binding potential BPP, and alternative outcome measures BPF and BPND, were determined for [11C]DASB in six a priori brain regions of interest (ROIs) using likelihood estimation in graphical analysis (LEGA) to calculate radioligand total distribution volume (VT), and a validated hybrid deconvolution approach (HYDECA) that estimates radioligand non-displaceable distribution volume (VND) without a reference region. Linear mixed models used PUFA levels as predictors and binding potential measures as outcomes across the specified ROIs; age and sex as fixed effects; and subject as random effect to account for across-region binding correlations. As nonlinear relationships were observed, a quadratic term was added to final models. RESULTS AA predicted both 5-HTT BPP and depression severity nonlinearly, described by an inverted U-shaped curve. 5-HTT binding potential mediated the relationship between AA and depression severity. LIMITATIONS Given the small sample and multiple comparisons, results require replication. CONCLUSIONS Our findings suggest that AA status may impact depression pathophysiology through effects on serotonin transport. Future studies should examine whether these relationships explain therapeutic effects of PUFAs in the treatment of MDD.
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Affiliation(s)
- Manesh Gopaldas
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA,Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Francesca Zanderigo
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
| | - Serena Zhan
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - R. Todd Ogden
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Jeffrey M. Miller
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
| | - Harry Rubin-Falcone
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA
| | - Thomas B. Cooper
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA,Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Maria A. Oquendo
- Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - J. John Mann
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA,Department of Radiology, Columbia University, New York, NY, USA
| | - M. Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY, USA,Molecular Imaging & Neuropathology Area, New York State Psychiatric Institute, New York, NY, USA,To whom correspondence should be addressed: New York State Psychiatric Institute, 1051 Riverside Drive, Unit 42, New York, NY 10032, Tel: 646 774-7514, Fax: 646 774-7589,
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31
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Ho TC, Cichocki AC, Gifuni AJ, Catalina Camacho M, Ordaz SJ, Singh MK, Gotlib IH. Reduced dorsal striatal gray matter volume predicts implicit suicidal ideation in adolescents. Soc Cogn Affect Neurosci 2019; 13:1215-1224. [PMID: 30256980 PMCID: PMC6234322 DOI: 10.1093/scan/nsy089] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/23/2018] [Indexed: 11/20/2022] Open
Abstract
Suicidal ideation (SI), a potent risk factor for suicide attempts, increases in adolescence. While alterations in dopaminergic functioning have been implicated in suicidal acts—particularly in adults—we do not know whether morphological alterations in dopamine-rich regions of the brain, such as the striatum, are vulnerability factors for the emergence of SI in adolescents. At baseline, a community sample of 152 adolescents (89 female; mean age: 11.41 ± 1.01 years) completed a magnetic resonance imaging (MRI) scan that was used to estimate gray matter volumes (GMVs) of three striatal structures: caudate, nucleus accumbens and putamen. At a 24 month follow-up session, participants completed a self-report measure of SI frequency [Suicidal Ideation Questionnaire (SIQ)] and the death version of the Implicit Association Test (IAT). Robust linear regression models were conducted to predict SIQ and IAT scores from striatal GMV. Bilateral putamen and left caudate GMV significantly predicted IAT scores (all Ps < 0.03). No other associations were significant (all Ps > 0.05). Our finding of reduced dorsal striatal GMV predicting implicit SI may indicate that downstream dopaminergic dysfunction is implicated in the development of overt suicidal behaviors. Self-reported SI was not associated with striatal GMV, suggesting that biological correlates of suicide risk may correlate specifically with objective measurements of SI in adolescents.
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Affiliation(s)
- Tiffany C Ho
- Department of Psychology, Stanford University, Stanford, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Anna C Cichocki
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Anthony J Gifuni
- McGill University and Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Sarah J Ordaz
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Manpreet K Singh
- University of Pittsburgh, Center for Neuroscience, Pittsburgh, PA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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Steinberg LJ, Rubin-Falcone H, Galfalvy HC, Kaufman J, Miller JM, Sublette ME, Cooper TB, Min E, Keilp JG, Stanley BH, Oquendo MA, Ogden RT, Mann JJ. Cortisol Stress Response and in Vivo PET Imaging of Human Brain Serotonin 1A Receptor Binding. Int J Neuropsychopharmacol 2019; 22:329-338. [PMID: 30927011 PMCID: PMC6499240 DOI: 10.1093/ijnp/pyz009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/07/2018] [Accepted: 02/15/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Abnormalities in the hypothalamic-pituitary-adrenal axis, serotonergic system, and stress response have been linked to the pathogenesis of major depressive disorder. State-dependent hyper-reactivity of the hypothalamic-pituitary-adrenal axis is seen in major depressive disorder, and higher binding to the serotonin 1A receptor is observed as a trait in both currently depressed and remitted untreated major depressive disorder. Here, we sought to examine whether a relationship exists between cortisol secretion in response to a stressor and serotonin 1A receptor binding throughout the brain, both in healthy controls and participants with major depressive disorder. METHODS Research participants included 42 medication-free, depressed subjects and 31 healthy volunteers. Participants were exposed to either an acute, physical stressor (radial artery catheter insertion) or a psychological stressor (Trier Social Stress Test). Levels of serotonin 1A receptor binding on positron emission tomography with [11C]WAY-100635 were also obtained from all participants. The relationship between [11C]WAY-100635 binding and cortisol was examined using mixed linear effects models with group (major depressive disorder vs control), cortisol, brain region, and their interactions as fixed effects and subject as a random effect. RESULTS We found a positive correlation between post-stress cortisol measures and serotonin 1A receptor ligand binding levels across multiple cortical and subcortical regions, independent of diagnosis and with both types of stress. The relationship between [11C]WAY-100635 binding and cortisol was homogenous across all a priori brain regions. In contrast, resting cortisol levels were negatively correlated with serotonin 1A receptor ligand binding levels independently of diagnosis, except in the RN. There was no significant difference in cortisol between major depressive disorder participants and healthy volunteers with either stressor. Similarly, there was no correlation between cortisol and depression severity in either stressor group. CONCLUSIONS This study suggests that there may be a common underlying mechanism that links abnormalities in the serotonin system and hypothalamic-pituitary-adrenal axis hyper-reactivity to stress. Future studies need to determine how hypothalamic-pituitary-adrenal axis dysfunction affects mood to increase the risk of suicide in major depression.
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Affiliation(s)
- Louisa J Steinberg
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Correspondence: Louisa J. Steinberg, MD, PhD, 1051 Riverside Drive, New York, NY 10032 ()
| | - Harry Rubin-Falcone
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Hanga C Galfalvy
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Joshua Kaufman
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Jeffrey M Miller
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - M Elizabeth Sublette
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Thomas B Cooper
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Nathan S. Kline Institute for Psychiatric Research, New York, NY
| | - Eli Min
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - John G Keilp
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Barbara H Stanley
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY
| | - Maria A Oquendo
- Psychiatry Department, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - R Todd Ogden
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - J John Mann
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY,Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY,Department of Radiology, Columbia University, New York, NY
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Preliminary examination of gray and white matter structure and longitudinal structural changes in frontal systems associated with future suicide attempts in adolescents and young adults with mood disorders. J Affect Disord 2019; 245:1139-1148. [PMID: 30699858 PMCID: PMC6487887 DOI: 10.1016/j.jad.2018.11.097] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mood disorders are major risk factors for suicidal behavior. While cross-sectional studies implicate frontal systems, data to aid prediction of suicide-related behavior in mood disorders are limited. Longitudinal research on neuroanatomical mechanisms underlying suicide risk may assist in developing targeted interventions. Therefore, we conducted a preliminary study investigating baseline gray and white matter structure and longitudinal structural changes associated with future suicide attempts. METHODS High-resolution structural magnetic resonance imaging, diffusion tensor imaging, and suicide-related behavioral assessment data for 46 adolescents and young adults with mood disorders [baseline agemean = 18 years; 61% female] were collected at baseline and at follow-up (intervalmean = 3 years). Differences in baseline and longitudinal changes in gray matter volume and white matter fractional anisotropy in frontal systems that distinguished the participants who made future attempts from those who did not were investigated. RESULTS Seventeen (37%) of participants attempted suicide within the follow-up period. Future attempters (those attempting suicide between their baseline and follow-up assessment), compared to those who did not, showed lower baseline ventral and rostral prefrontal gray matter volume and dorsomedial frontal, anterior limb of the internal capsule, and dorsal cingulum fractional anisotropy, as well as greater decreases over time in ventral and dorsal frontal fractional anisotropy (p < 0.005, uncorrected). LIMITATIONS Sample size was modest. CONCLUSIONS Results suggest abnormalities of gray and white matter in frontal systems and differences in developmental changes of frontal white matter may increase risk of suicide-related behavior in youths with mood disorders. Findings provide potential new leads for early intervention and prevention strategies.
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Mann JJ, Metts AV, Ogden RT, Mathis CA, Rubin-Falcone H, Gong Z, Drevets WC, Zelazny J, Brent DA. Quantification of 5-HT 1A and 5-HT 2A receptor Binding in Depressed Suicide Attempters and Non-Attempters. Arch Suicide Res 2019; 23:122-133. [PMID: 29281590 DOI: 10.1080/13811118.2017.1417185] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine serotonin system abnormalities related to major depression or previous suicidal behavior. METHODS [11C]WAY100635, [18F]altanserin and positron emission tomography were used to compare 5-HT1A and 5-HT2A binding in MDD patients divided into eight past suicide attempters (>4yrs prior to scanning) and eight lifetime non-attempters, and both groups were compared to eight healthy volunteers. RESULTS The two receptor types differed in binding pattern across brain regions from each other, but there were no differences in binding between healthy volunteers and the two depressed groups or between depressed suicide attempters and non-attempters. No effects of depression severity or lifetime aggression were observed for either receptor. CONCLUSION Limitations of this study include small sample size and absence of high lethality suicide attempts in the depressed attempter group. No trait-like binding correlations with past suicide attempt or current depression were observed. Given the heterogeneity of nonfatal suicidal behavior, a larger sample study emphasizing higher lethality suicide attempts may find the serotonin biological phenotype seen in suicide decedents.
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Ambrosi E, Arciniegas DB, Curtis KN, Patriquin M, Spalletta G, Sani G, Frueh BC, Fowler JC, Madan A, Salas R. Resting-State Functional Connectivity of the Habenula in Mood Disorder Patients With and Without Suicide-Related Behaviors. J Neuropsychiatry Clin Neurosci 2019; 31:49-56. [PMID: 30282513 PMCID: PMC6697145 DOI: 10.1176/appi.neuropsych.17120351] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The habenula is a small midbrain structure that is important for brain signaling and learning from negative events. Thus, the habenula is strongly connected to both the reward system and motor regions. Increasing evidence suggests a role for the habenula in the etiology of psychiatric disorders, including mood and substance use disorders. However, no studies to date have investigated habenular resting-state functional connectivity (rsFC) in suicide-related behaviors (SB). The authors enrolled 123 individuals with major depressive disorder (MDD) or bipolar disorder and a history of suicide-related behaviors (SB+), 74 individuals with MDD or bipolar disorder and a history of suicidal ideation but no history of SB (SB-), and 75 healthy control subjects (HC). A seed-based approach was used to identify regions showing different rsFC with the habenula followed by region of interest to region of interest post hoc comparisons. Compared with both the SB- and HC groups, the SB+ group showed higher connectivity between the left habenula and the left parahippocampal gyrus, the right amygdala, and the right precentral and postcentral gyri. Patients with mood disorders displayed higher rsFC between the left habenula and left middle temporal gyrus, the left angular gyrus, and the left posterior cingulate cortex, as well as lower rsFC between the right habenula and the left thalamus, when compared with HCs. These findings suggest that the habenula is involved in the neural circuitry of suicide. The higher habenular rsFC found in the SB+ group may mediate a dysfunction in the mechanism that links the habenula with motor activity and contextual associative processing.
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Affiliation(s)
- Elisa Ambrosi
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX,IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - David B Arciniegas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX
| | - Kaylah N Curtis
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Michael E DeBakey VA Medical Center, Houston TX, USA
| | - Michelle Patriquin
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Michael E DeBakey VA Medical Center, Houston TX, USA
| | - Gianfranco Spalletta
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Baylor College of Medicine, Houston, TX,IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs Department (NESMOS), Sapienza University, Rome, School of Medicine and Psychology, Sant’ Andrea Hospital, Rome, Italy,Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - J Christopher Fowler
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Alok Madan
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Ramiro Salas
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX,Michael E DeBakey VA Medical Center, Houston TX, USA
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Underwood MD, Kassir SA, Bakalian MJ, Galfalvy H, Dwork AJ, Mann JJ, Arango V. Serotonin receptors and suicide, major depression, alcohol use disorder and reported early life adversity. Transl Psychiatry 2018; 8:279. [PMID: 30552318 PMCID: PMC6294796 DOI: 10.1038/s41398-018-0309-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 01/19/2023] Open
Abstract
Serotonin neurotransmitter deficits are reported in suicide, major depressive disorder (MDD) and alcohol use disorder (AUD). To compare pathophysiology in these disorders, we mapped brain serotonin transporter (SERT), 5-HT1A, and 5-HT2A receptor binding throughout prefrontal cortex and in anterior cingulate cortex postmortem. Cases and controls died suddenly minimizing agonal effects and had a postmortem interval ≤24 h to avoid compromised brain integrity. Neuropathology and toxicology confirmed absence of neuropathology and psychotropic medications. For most subjects (167 of 232), a DSM-IV Axis I diagnosis was made by psychological autopsy. Autoradiography was performed in right hemisphere coronal sections at a pre-genual level. Linear model analyses included sex and age with group and Brodmann area as interaction terms. SERT binding was lower in suicides (p = 0.004) independent of sex (females < males, p < 0.0001), however, the lower SERT binding was dependent on MDD diagnosis (p = 0.014). Higher SERT binding was associated with diagnosis of alcoholism (p = 0.012). 5-HT1A binding was greater in suicides (p < 0.001), independent of MDD (p = 0.168). Alcoholism was associated with higher 5-HT1A binding (p < 0.001) but only in suicides (p < 0.001). 5-HT2A binding was greater in suicides (p < 0.001) only when including MDD (p = 0.117) and alcoholism (p = 0.148) in the model. Reported childhood adversity was associated with higher SERT and 5-HT1A binding (p = 0.004) in nonsuicides and higher 5-HT2A binding (p < 0.001). Low SERT and more 5-HT1A and 5-HT2A binding in the neocortex in depressed suicides is dependent on Axis I diagnosis and reported childhood adversity. Findings in alcoholism differed from those in depression and suicide indicating a distinct serotonin system pathophysiology.
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Affiliation(s)
- Mark D Underwood
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA.
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
| | - Suham A Kassir
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Mihran J Bakalian
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Hanga Galfalvy
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
- Division of Biostatistics, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Andrew J Dwork
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Macedonian Academy of Sciences and Arts, Skopje, Macedonia
| | - J John Mann
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Victoria Arango
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Division of Molecular Imaging and Neuropathology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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Courtet P, Olié E. [Social pain at the core of suicidal behavior]. Encephale 2018; 45 Suppl 1:S7-S12. [PMID: 30428996 DOI: 10.1016/j.encep.2018.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 08/31/2018] [Accepted: 09/08/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Intolerable pain is often reported in suicide notes. Moreover, the frequency of life events preceding a suicidal act is high, especially interpersonal difficulties. Such adversity is the source of psychological or social pain. METHODS We propose a narrative review to discuss the role of pain in the suicidal process while having a focus on social ties. RESULTS Using Ecological Momentary Assessment in suicide attempters it has been shown that being alone increased suicidal ideation while being with close others significantly reduced this risk. At a neuroanatomical level, suicidal vulnerability is associated with dysfunctional insula activation during social exclusion, a region involved in social and physical pain processing. Social pain elicited by social exclusion or devaluation shares common neurobiological patterns with physical pain. It is also an exemplar of psychological pain. Despite the complexity of its definition, higher psychological pain levels are associated with suicidal ideation and acts. Finally, intense physical pain or chronic pain are strong risk factors of suicidal ideation and act. Interestingly, suicide notes often report the existence of an intolerable pain. Presence of psychological pain and difficulties in communication predict the lethality and seriousness of suicide attempts. Moreover, presence of psychological pain is associated with more impulsive choices in suicidal patients, suggesting that a suicidal act is a means to escape intolerable suffering despite negative long-term consequences (i.e. death). Analgesics are usually used to get relief from pain but are also frequently involved in suicidal overdoses. It has been shown that opioid analgesics are associated with an increased risk of suicide. Higher consumption of opioid analgesics has been shown in suicidal patients in comparison to patients with history of depression but no suicidal act and healthy controls whereas non-suicidal patients were those reporting higher presence of pain in comparison to healthy controls. It may suggest that opioids are being used by suicidal patients to get relief from psychological/social pain rather than from physical pain. Involvement of opioidergic system in suicidal process opens new therapeutic strategies. Recently, the time-limited, short-term use of very low dosages of sublingual buprenorphine (vs. placebo) was associated with decreased suicidal ideation and mental pain in severely suicidal patients without substance abuse. In a randomized controlled trial comparing a 7-week acceptance and commitment therapy (ACT) versus relaxation group, as adjunct to treatment as usual for adult outpatients suffering from a current suicidal behavior disorder, ACT has shown its effectiveness in reducing suicidal ideation and psychological pain. Evidence indicates that maintaining contact either via letter, postcard or telephone with at-risk adults following discharge from care services after a suicide attempt can reduce reattempt risk. Based on these results, a preventive program of recontact for suicide attempters, VIGILANS, has been developed in France in usual care. CONCLUSION The approach of the suicidal issue by the angle of pain and social disconnection offers new advances to improve clinical assessment, to identify new biological pathways involved in suicidal risk, and to propose innovative therapeutic and preventive actions.
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Affiliation(s)
- P Courtet
- Département d'urgence et post-urgence psychiatrique, université Montpellier, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - E Olié
- Département d'urgence et post-urgence psychiatrique, université Montpellier, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
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Olié E, Courtet P. Interest of neuroimaging of social exclusion in suicide. J Neurosci Res 2018; 98:581-587. [PMID: 30171628 DOI: 10.1002/jnr.24314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 12/24/2022]
Abstract
With one million deaths worldwide, suicide is a major health issue. The frequency of life events preceding suicidal act is high and raises the question of their role in suicidal process. At biological level, dysfunctional neural processing of social exclusion may participate in suicidal risk through an increased perception of social adversity in vulnerable subjects. The purpose of this narrative review is to discuss neuroimaging findings related to social exclusion and loneliness, and to open new perspectives to investigate sensitivity to social stress in suicide.
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Affiliation(s)
- Emilie Olié
- Department of Emergency Psychiatry & Post Acute Care, Academic hospital of Montpellier, Montpellier University, & INSERM U1061, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Post Acute Care, Academic hospital of Montpellier, Montpellier University, & INSERM U1061, Montpellier, France
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Daray FM, Arena ÁR, Armesto AR, Rodante DE, Puppo S, Vidjen P, Portela A, Grendas LN, Errasti AE. Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts. Eur Psychiatry 2018; 54:19-26. [DOI: 10.1016/j.eurpsy.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/08/2018] [Accepted: 07/04/2018] [Indexed: 01/16/2023] Open
Abstract
AbstractObjective:The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship.Methods:A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months.Results:At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity.Conclusion:The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.
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Maruani J, Anderson G, Etain B, Lejoyeux M, Bellivier F, Geoffroy PA. The neurobiology of adaptation to seasons: Relevance and correlations in bipolar disorders. Chronobiol Int 2018; 35:1335-1353. [DOI: 10.1080/07420528.2018.1487975] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Julia Maruani
- Inserm, U1144, Paris, France
- Université Paris Descartes, UMR-S 1144, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France
- AP-HP, GH Saint-Louis – Lariboisière – F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
- Fondation FondaMental, Créteil, France
| | | | - Bruno Etain
- Inserm, U1144, Paris, France
- Université Paris Descartes, UMR-S 1144, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France
- AP-HP, GH Saint-Louis – Lariboisière – F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
- Fondation FondaMental, Créteil, France
| | - Michel Lejoyeux
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France
- Department of Epidemiology, Paris Hospital Group – Psychiatry & Neurosciences, Paris, France
- Department of Psychiatry and Addictive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospital Bichat-Claude Bernard, Paris, France
- Paris Diderot University – Paris VII, Paris, France
| | - Frank Bellivier
- Inserm, U1144, Paris, France
- Université Paris Descartes, UMR-S 1144, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France
- AP-HP, GH Saint-Louis – Lariboisière – F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
- Fondation FondaMental, Créteil, France
| | - Pierre A. Geoffroy
- Inserm, U1144, Paris, France
- Université Paris Descartes, UMR-S 1144, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France
- AP-HP, GH Saint-Louis – Lariboisière – F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France
- Fondation FondaMental, Créteil, France
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Consoloni JL, Ibrahim EC, Lefebvre MN, Zendjidjian X, Olié E, Mazzola-Pomietto P, Desmidt T, Samalin L, Llorca PM, Abbar M, Lopez-Castroman J, Haffen E, Baumstarck K, Naudin J, Azorin JM, El-Hage W, Courtet P, Belzeaux R. Serotonin transporter gene expression predicts the worsening of suicidal ideation and suicide attempts along a long-term follow-up of a Major Depressive Episode. Eur Neuropsychopharmacol 2018; 28:401-414. [PMID: 29287766 DOI: 10.1016/j.euroneuro.2017.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 12/27/2022]
Abstract
The quest for biomarkers in suicidal behaviors has been elusive so far, despite their potential utility in clinical practice. One of the most robust biological findings in suicidal behaviors is the alteration of the serotonin transporter function in suicidal individuals. Our main objective was to investigate the predictive value of the serotonin transporter gene expression (SLC6A4) for suicidal ideation and as secondary, for suicide attempts in individuals with a major depressive episode (MDE). A 30-week prospective study was conducted on 148 patients with a MDE and 100 healthy controls including 4 evaluation times (0, 2, 8 and 30 weeks). Blood samples and clinical data were collected and SLC6A4 mRNA levels were measured from peripheral blood mononuclear cells using RT-qPCR. We first demonstrated the stability and reproducibility of SLC6A4 mRNA expression measures over time in healthy controls (F=0.658; p=0.579; η2=0.008; ICC=0.91, 95% CI [0.87-0.94]). Baseline SLC6A4 expression level (OR=0.563 [0.340-0.932], p=0.026) as well as early changes in SLC6A4 expression between baseline and the 2nd week (β=0.200, p=0.042) predicted the worsening of suicidal ideation (WSI) in the following 8 weeks. Moreover, changes in SLC6A4 expression between the 2nd and 8th weeks predicted the occurrence of a suicide attempt within 30 weeks (OR=10.976 [1.438-83.768], p=0.021). Altogether, the baseline level and the changes in SLC6A4 mRNA expression during a MDE might predict the WSI and the occurrence of suicidal attempts and could be a useful biomarker in clinical practice.
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Affiliation(s)
- Julia-Lou Consoloni
- APHM, Department of psychiatry, Marseille, France; Aix Marseille Univ, CNRS, CRN2M, UMR 7286, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France
| | - El Chérif Ibrahim
- Aix Marseille Univ, CNRS, CRN2M, UMR 7286, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | | | - Xavier Zendjidjian
- APHM, Department of psychiatry, Marseille, France; Aix Marseille Univ, SPMC, EA 3279, Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France
| | - Emilie Olié
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; Inserm, U1061, University of Montpellier, Montpellier, France
| | | | - Thomas Desmidt
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France; Inserm U1253 Imaging & Brain, Université de Tours, Tours, France
| | - Ludovic Samalin
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; CHU Clermont-Ferrand, Department of Psychiatry, EA 7280, University of Clermont Auvergne, Clermont-Ferrand, France
| | - Mocrane Abbar
- Department of Adult Psychiatry, CHRU Nimes, Nimes, France
| | - Jorge Lopez-Castroman
- Inserm, U1061, University of Montpellier, Montpellier, France; Department of Adult Psychiatry, CHRU Nimes, Nimes, France
| | - Emmanuel Haffen
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Department of Clinical Psychiatry, University Hospital, Besançon, France; EA 481, Laboratory of Neurosciences, University of Franche-Comté, Besançon, France; CIC-1431 Inserm, University Hospital, Besançon, France
| | - Karine Baumstarck
- Aix Marseille Univ, SPMC, EA 3279, Public Health, Chronic Diseases and Quality of Life - Research Unit, Marseille, France
| | - Jean Naudin
- APHM, Department of psychiatry, Marseille, France
| | - Jean-Michel Azorin
- APHM, Department of psychiatry, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Aix Marseille Univ, CNRS, INT, Inst Neurosci Timone, Marseille, France
| | - Wissam El-Hage
- CHRU de Tours, Clinique Psychiatrique Universitaire, Tours, France; Inserm U1253 Imaging & Brain, Université de Tours, Tours, France; Inserm CIC 1415, Centre d'Investigation Clinique, CHRU de Tours, Tours, France
| | - Philippe Courtet
- Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; Department of Emergency Psychiatry and Acute Care, CHU Montpellier, France; Inserm, U1061, University of Montpellier, Montpellier, France
| | - Raoul Belzeaux
- APHM, Department of psychiatry, Marseille, France; Aix Marseille Univ, CNRS, CRN2M, UMR 7286, Marseille, France; Fondation FondaMental, Fondation de Recherche et de Soins en Santé Mentale, Créteil, France; McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, QC, Canada.
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Balcioglu YH, Kose S. Neural substrates of suicide and suicidal behaviour: from a neuroimaging perspective. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2017.1420378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Yasin Hasan Balcioglu
- Neurology, and Neurosurgery, Forensic Psychiatry Unit, Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Istanbul, Turkey
| | - Samet Kose
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
- Department of Psychiatry, University of Texas Medical School of Houston, Houston, TX, USA
- eCenter for Neurobehavioral Research on Addictions, Houston, TX, USA
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Holmes SE, Hinz R, Conen S, Gregory CJ, Matthews JC, Anton-Rodriguez JM, Gerhard A, Talbot PS. Elevated Translocator Protein in Anterior Cingulate in Major Depression and a Role for Inflammation in Suicidal Thinking: A Positron Emission Tomography Study. Biol Psychiatry 2018; 83:61-69. [PMID: 28939116 DOI: 10.1016/j.biopsych.2017.08.005] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Major depressive disorder is associated with raised peripheral inflammatory markers. Mounting evidence also suggests that inflammation is involved in suicidal behavior. However, the involvement of inflammation in the brains of individuals with depression, and its association with suicidal ideation, needs further clarification. Translocator protein (TSPO), which is upregulated in activated glia (predominantly microglia), can be measured as an indication of neuroinflammation in vivo using positron emission tomography and TSPO-specific radioligands. METHODS We used [11C](R)-PK11195 positron emission tomography to compare TSPO availability in the anterior cingulate cortex (ACC), prefrontal cortex, and insula between 14 medication-free patients in a major depressive episode of at least moderate severity and 13 matched healthy control subjects. In a post hoc analysis, we also compared TSPO availability between patients with and without suicidal thoughts. RESULTS Multivariate analysis of variance indicated significantly higher TSPO in patients compared with control subjects (p = .005). The elevation was of large effect size and significant in the ACC (p = .022, Cohen's d = 0.95), with smaller nonsignificant elevations in the prefrontal cortex (p = .342, Cohen's d = 0.38) and insula (p = .466, Cohen's d = 0.29). TSPO was not elevated in patients without suicidal thinking but was significantly increased in those with suicidal thoughts compared with those without, most robustly in the ACC (p = .008) and insula (p = .023). CONCLUSIONS We confirm evidence for increased TSPO availability, suggestive of predominantly microglial activation, in the ACC during a moderate to severe major depressive episode. Our findings provide further incentive for evaluating anti-inflammatory therapies in major depressive disorder.
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Affiliation(s)
- Sophie E Holmes
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Rainer Hinz
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Silke Conen
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Catherine J Gregory
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Julian C Matthews
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jose M Anton-Rodriguez
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Alexander Gerhard
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Peter S Talbot
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
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Stein MB, Ware EB, Mitchell C, Chen C, Borja S, Cai T, Dempsey CL, Fullerton CS, Gelernter J, Heeringa SG, Jain S, Kessler RC, Naifeh JA, Nock MK, Ripke S, Sun X, Beckham JC, Kimbrel NA, Ursano RJ, Smoller JW. Genomewide association studies of suicide attempts in US soldiers. Am J Med Genet B Neuropsychiatr Genet 2017; 174:786-797. [PMID: 28902444 PMCID: PMC5685938 DOI: 10.1002/ajmg.b.32594] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/11/2017] [Indexed: 12/19/2022]
Abstract
Suicide is a global public health problem with particular resonance for the US military. Genetic risk factors for suicidality are of interest as indicators of susceptibility and potential targets for intervention. We utilized population-based nonclinical cohorts of US military personnel (discovery: N = 473 cases and N = 9778 control subjects; replication: N = 135 cases and N = 6879 control subjects) and a clinical case-control sample of recent suicide attempters (N = 51 cases and N = 112 control subjects) to conduct GWAS of suicide attempts (SA). Genomewide association was evaluated within each ancestral group (European-, African-, Latino-American) and study using logistic regression models. Meta-analysis of the European ancestry discovery samples revealed a genomewide significant locus in association with SA near MRAP2 (melanocortin 2 receptor accessory protein 2) and CEP162 (centrosomal protein 162); 12 genomewide significant SNPs in the region; peak SNP rs12524136-T, OR = 2.88, p = 5.24E-10. These findings were not replicated in the European ancestry subsamples of the replication or suicide attempters samples. However, the association of the peak SNP remained significant in a meta-analysis of all studies and ancestral subgroups (OR = 2.18, 95%CI 1.70, 2.80). Polygenic risk score (PRS) analyses showed some association of SA with bipolar disorder. The association with SNPs encompassing MRAP2, a gene expressed in brain and adrenal cortex and involved in neural control of energy homeostasis, points to this locus as a plausible susceptibility gene for suicidality that should be further studied. Larger sample sizes will be needed to confirm and extend these findings.
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Affiliation(s)
- Murray B. Stein
- Department of PsychiatryUniversity of California San Diego and VA San Diego Healthcare SystemLa JollaCalifornia
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCalifornia
| | - Erin B. Ware
- Institute for Social ResearchUniversity of MichiganAnn ArborMichigan
| | - Colter Mitchell
- Institute for Social ResearchUniversity of MichiganAnn ArborMichigan
| | - Chia‐Yen Chen
- Department of Psychiatry, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic MedicineMassachusetts General HospitalBostonMassachusetts
- Stanley Center for Psychiatric ResearchBroad Institute of MIT and HarvardCambridgeMassachusetts
| | - Susan Borja
- National Institute of Mental HealthBethesdaMaryland
| | - Tianxi Cai
- Harvard T.H. Chan School of Public HealthBostonMassachusetts
| | | | | | - Joel Gelernter
- Departments of Psychiatry, Genetics, and NeurobiologyYale UniversityNew HavenConnecticut
| | | | - Sonia Jain
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCalifornia
| | - Ronald C. Kessler
- Department of Health Care PolicyHarvard Medical SchoolBostonMassachusetts
| | - James A. Naifeh
- Uniformed Services University of the Health SciencesBethesdaMaryland
| | - Matthew K. Nock
- Department of PsychologyHarvard UniversityCambridgeMassachusetts
| | - Stephan Ripke
- Stanley Center for Psychiatric ResearchBroad Institute of MIT and HarvardCambridgeMassachusetts
| | - Xiaoying Sun
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCalifornia
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System and Duke University Health SystemDurhamNorth Carolina
- VA MIRECCDurhamNorth Carolina
| | - Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System and Duke University Health SystemDurhamNorth Carolina
- VA MIRECCDurhamNorth Carolina
| | - Robert J Ursano
- Uniformed Services University of the Health SciencesBethesdaMaryland
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic MedicineMassachusetts General HospitalBostonMassachusetts
- Stanley Center for Psychiatric ResearchBroad Institute of MIT and HarvardCambridgeMassachusetts
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Ballard ED, Snider SL, Nugent AC, Luckenbaugh DA, Park L, Zarate CA. Active suicidal ideation during clinical antidepressant trials. Psychiatry Res 2017; 257:303-308. [PMID: 28787656 PMCID: PMC5626625 DOI: 10.1016/j.psychres.2017.07.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/05/2017] [Accepted: 07/29/2017] [Indexed: 01/21/2023]
Abstract
Suicidal patients are often excluded from clinical trials of psychiatric medications and from investigations using neurobiological techniques. To evaluate the presence, impact, and stability of active suicidal ideation (SI) across a range of antidepressant trials, we reviewed 14 clinical trials conducted in patients with either major depressive disorder (MDD) or bipolar disorder (BD) (N = 269). Active SI at any time point in the clinical trial was identified and linked to participation in other research procedures. Stability of active SI across subsequent days was evaluated using intraclass correlation coefficients (ICCs) and compared to other depressive symptoms. Across 14 clinical trials, 63 participants (23%) reported active SI at some point during study participation. Of these participants, 33 completed a neuroimaging procedure and 16 completed polysomnography within a week of active SI. When active SI was subsequently assessed, only 39% of patients continued to report active SI after three days of assessment, despite receiving no additional treatment. ICCs were not significant for either SI or pessimism; other depressive symptoms showed stability over time. The results suggest that research can be conducted in depressed patients with active SI if such research coincides with careful observation. Active SI and pessimism may be particularly vulnerable to fluctuation.
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Affiliation(s)
- Elizabeth D Ballard
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Sam L Snider
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Allison C Nugent
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - David A Luckenbaugh
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Lawrence Park
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Carlos A Zarate
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
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Kang SG, Na KS, Choi JW, Kim JH, Son YD, Lee YJ. Resting-state functional connectivity of the amygdala in suicide attempters with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:222-227. [PMID: 28445688 DOI: 10.1016/j.pnpbp.2017.04.029] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 02/05/2023]
Abstract
In this study, we investigated the difference in resting-state functional connectivity (RSFC) of the amygdala between suicide attempters and non-suicide attempters with major depressive disorder (MDD) using functional magnetic resonance imaging (fMRI). This study included 19 suicide attempters with MDD and 19 non-suicide attempters with MDD. RSFC was compared between the two groups and the regression analyses were conducted to identify the correlation between RSFC and Scale for Suicide Ideation (SSI) scores in the suicide attempt group. Statistical significance was set at p-value (uncorrected) <0.005 with k≥28 voxels. Compared with non-suicide attempters, suicide attempters showed significantly increased RSFC of the left amygdala with the right insula and left superior orbitofrontal area, and increased RSFC of the right amygdala with the left middle temporal area. The regression analysis showed a significant correlation between the SSI total score and RSFC of the right amygdala with the right parahippocampal area in the suicide attempt group. The present RSFC findings provide evidence of a functional neural basis and will help reveal the pathophysiology underlying suicidality in subjects with MDD.
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Affiliation(s)
- Seung-Gul Kang
- Department of Psychiatry, Gil Medical Center, Gachon University, School of Medicine, Incheon, Republic of Korea
| | - Kyoung-Sae Na
- Department of Psychiatry, Gil Medical Center, Gachon University, School of Medicine, Incheon, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - Jeong-Hee Kim
- Research Institute for Advanced Industrial Technology, College of Science and Technology, Korea University, Republic of Korea
| | - Young-Don Son
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, Republic of Korea.
| | - Yu Jin Lee
- Department of Psychiatry, Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Abstract
PURPOSE OF REVIEW The rising suicide rate in the USA will not be reversed without improved risk assessment and prevention practices. To date, the best method for clinicians to assess a patient's risk for suicide is screening for past suicide attempts in the patient and their family. However, neuroimaging, genomic, and biochemical studies have generated a body of findings that allow description of an initial heuristic biological model for suicidal behavior that may have predictive value. RECENT FINDINGS We review studies from the past 3 years examining potential biological predictors of suicide attempt behavior. We divide findings into two major categories: (1) structural and functional brain imaging findings and (2) biochemical and genomic findings encompassing several systems, including major neurotransmitters (serotonin, catecholamines, GABA, and glutamate), the hypothalamic pituitary adrenal (HPA) axis, the inflammasome, lipids, and neuroplasticity. The biomarkers that appear promising for assessing suicide risk in clinical settings include indices of serotonergic function, inflammation, neuronal plasticity, and lipids.
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Olié E, Jollant F, Deverdun J, de Champfleur NM, Cyprien F, Le Bars E, Mura T, Bonafé A, Courtet P. The experience of social exclusion in women with a history of suicidal acts: a neuroimaging study. Sci Rep 2017; 7:89. [PMID: 28273888 PMCID: PMC5428048 DOI: 10.1038/s41598-017-00211-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/14/2017] [Indexed: 12/18/2022] Open
Abstract
Suicidal behaviors result from a complex interaction between social stressors and individual vulnerability. However, little is known of the specific neural network supporting the sensitivity to social stressors in patients at risk of suicidal acts. Using functional Magnetic Resonance Imaging, we investigated brain processing of social rejection in suicide attempters. Thirty-six euthymic women with a history of depression and suicidal behavior were compared to 41 euthymic women with a history of depression but no suicidal attempt, and 28 healthy controls. The Cyberball Game was used as a validated social exclusion paradigm. Relative to healthy controls, both patient groups reported higher levels of social distress related to the task, without significant differences according to suicidal status. Compared to patients without any history of suicide attempt and healthy controls, suicide attempters showed decreased contrast in the left insula and supramarginal gyrus during the exclusion vs. inclusion condition, after controlling for number of depressive episodes, medication, mood disorder type or social phobia. Our study highlights impaired brain response to social exclusion in euthymic female suicide attempters in regions previously implicated in pain tolerance and social cognition. These findings suggest sustained brain dysfunctions related to social perception in suicide attempters.
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Affiliation(s)
- Emilie Olié
- Department of Emergency Psychiatry & Post Acute Care, Academic hospital of Montpellier, Montpellier University, & INSERM U1061, Montpellier, France.
| | - Fabrice Jollant
- Department of Psychiatry, Academic hospital of Nimes, Nimes, France
- McGill University, Department of psychiatry, and Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montreal, Québec, Canada
| | - Jeremy Deverdun
- Department of Neuroradiology, Academic hospital of Montpellier & U1051, Institut of Neurosciences of Montpellier, Montpellier, France
| | - Nicolas Menjot de Champfleur
- Department of Neuroradiology, Academic hospital of Montpellier & U1051, Institut of Neurosciences of Montpellier, Montpellier, France
- I2FH & CNRS UMR 5221, University of Montpellier, Montpellier, France
| | - Fabienne Cyprien
- Neurosurgery, Academic Hospital of Montpellier & INSERM U1061, Montpellier, France
| | - Emmanuelle Le Bars
- Department of Neuroradiology, Academic hospital of Montpellier & U1051, Institut of Neurosciences of Montpellier, Montpellier, France
- I2FH & CNRS UMR 5221, University of Montpellier, Montpellier, France
| | - Thibaut Mura
- Center for clinical investigation, Academic hospital of Montpelier, Montpellier University, Montpellier, France
| | - Alain Bonafé
- Department of Neuroradiology, Academic hospital of Montpellier & U1051, Institut of Neurosciences of Montpellier, Montpellier, France
| | - Philippe Courtet
- Department of Emergency Psychiatry & Post Acute Care, Academic hospital of Montpellier, Montpellier University, & INSERM U1061, Montpellier, France
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49
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Juruena MF, Agustini B, Cleare AJ, Young AH. A translational approach to clinical practice via stress-responsive glucocorticoid receptor signaling. Stem Cell Investig 2017; 4:13. [PMID: 28275643 DOI: 10.21037/sci.2017.02.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 11/06/2022]
Abstract
A recent article by Kwan and colleagues could elegantly demonstrate the necessary interaction between neuronal serotonin (5-HT) systems and the hypothalamic-pituitary-adrenal (HPA) axis through glucocorticoid receptors (GR), producing an adequate stress response, in this case, responding to hypoxia with an increase in hematopoietic stem and progenitor cells (HSPC). There is an intricate system connecting brain, body and mind and this exchange is only possible when all these systems-nervous, endocrine, and immune-have receptors on critical cells to receive information (via messenger molecules) from each of the other systems. There is evidence that the expression and function of GR in the hippocampus, mainly MR, is regulated by the stimulation of 5-HT receptors. Stressful stimuli increase 5-HT release and turnover in the hippocampus, and it seems reasonable to suggest that some of the changes in mineralocorticoid and GR expression may be mediated, in part at least, by the increase in 5-HT. Also serotonin and HPA axis dysfunctions have already been implicated in a variety of psychiatric disorders, especially depression. Early life stress (ELS) can have profound impact on these systems and can predispose subjects to a variety of adult metabolic and psychiatric conditions. It is important to analyze the mechanisms of this complex interaction and its subsequent programming effects on the stress systems, so that we can find new ways and targets for treatment of psychiatric disorders. Different areas of research on basic biological sciences are now being integrated and this approach will hopefully provide several new insights, new pharmacological targets and improve our global understanding of these highly debilitating chronic conditions, that we now call mental disorders.
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Affiliation(s)
- Mario F Juruena
- Department of Neuroscience and Behavior, School of Medicine of Ribeirao Preto, University of Sao Paulo, Sao Paulo, Brazil;; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience-King's College London, London, UK
| | - Bruno Agustini
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience-King's College London, London, UK
| | - Anthony J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience-King's College London, London, UK
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience-King's College London, London, UK
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50
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Molina-Guzman G, González-Castro TB, Hernández Díaz Y, Tovilla-Zárate CA, Juárez-Rojop IE, Guzmán-Priego CG, Genis A, Pool García S, López-Narvaez ML, Rodriguez-Perez JM. Gender differences in the association between HTR2C gene variants and suicidal behavior in a Mexican population: a case-control study. Neuropsychiatr Dis Treat 2017; 13:559-566. [PMID: 28260903 PMCID: PMC5328611 DOI: 10.2147/ndt.s122024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The aim of this case-control study was to explore the association by gender between the HTR2C gene variants and suicidal behavior in a Mexican population. SUBJECTS AND METHODS A total of 183 suicide attempters and 208 healthy volunteers were included in this study. We genotyped five polymorphisms of HTR2C (rs547536, rs2192372, rs4272555, rs6318, and rs2428707), then measured the association by genotype, allele, and haplotype. RESULTS In the female group, we found an association between two polymorphisms of the HTR2C (rs4272555 and rs2428707) and suicide attempts. The C allele of the single-nucleotide polymorphism (SNP) rs4272555 was associated with a decreased risk of suicide attempt (P=0.01, odds ratio =0.26, 95% confidence interval: 0.09-0.79), whereas the G allele of the SNP rs2428707 was associated with an increased risk of suicide attempt (P=0.01, odds ratio =3.68, 95% confidence interval: 1.24-10.90). No significant association was observed between the other polymorphisms studied (rs547536, rs2192372, rs6318) or haplotypes with suicide attempts. CONCLUSION These findings suggest a possible risk factor of the HTR2C gene in the pathology of suicidal behavior in Mexican population. More studies are necessary to confirm this association.
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Affiliation(s)
- Gabriel Molina-Guzman
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa
| | | | - Yazmín Hernández Díaz
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez
| | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Isela E Juárez-Rojop
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | | | - Alma Genis
- Instituto Nacional de Medicina Genómica (INMEGEN), Servicios de Atención Psiquiátrica (SAP), Secretaría de Salud, Ciudad de México, México
| | | | | | - José Manuel Rodriguez-Perez
- Departamento de Biología Molecular, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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