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Lin P, Sun J, Lou X, Li D, Shi Y, Li Z, Ma P, Li P, Chen S, Jin W, Liu S, Chen Q, Gao Q, Zhu L, Xu J, Zhu M, Wang M, Liang K, Zhao L, Xu H, Dong K, Li Q, Cheng X, Chen J, Guo X. Consensus on potential biomarkers developed for use in clinical tests for schizophrenia. Gen Psychiatr 2022; 35:e100685. [PMID: 35309241 PMCID: PMC8867318 DOI: 10.1136/gpsych-2021-100685] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/07/2022] [Indexed: 12/12/2022] Open
Abstract
BackgroundSchizophrenia is a serious mental illness affecting approximately 20 million individuals globally. Both genetic and environmental factors contribute to the illness. If left undiagnosed and untreated, schizophrenia results in impaired social function, repeated hospital admissions, reduced quality of life and decreased life expectancy. Clinical diagnosis largely relies on subjective evidence, including self-reported experiences, and reported behavioural abnormalities followed by psychiatric evaluation. In addition, psychoses may occur along with other conditions, and the symptoms are often episodic and transient, posing a significant challenge to the precision of diagnosis. Therefore, objective, specific tests using biomarkers are urgently needed for differential diagnosis of schizophrenia in clinical practice.AimsWe aimed to provide evidence-based and consensus-based recommendations, with a summary of laboratory measurements that could potentially be used as biomarkers for schizophrenia, and to discuss directions for future research.MethodsWe searched publications within the last 10 years with the following keywords: ‘schizophrenia’, ‘gene’, ‘inflammation’, ‘neurotransmitter’, ‘protein marker’, ‘gut microbiota’, ‘pharmacogenomics’ and ‘biomarker’. A draft of the consensus was discussed and agreed on by all authors at a round table session.ResultsWe summarised the characteristics of candidate diagnostic markers for schizophrenia, including genetic, inflammatory, neurotransmitter, peripheral protein, pharmacogenomic and gut microbiota markers. We also proposed a novel laboratory process for diagnosing schizophrenia in clinical practice based on the evidence summarised in this paper.ConclusionsFurther efforts are needed to identify schizophrenia-specific genetic and epigenetic markers for precise diagnosis, differential diagnosis and ethnicity-specific markers for the Chinese population. The development of novel laboratory techniques is making it possible to use these biomarkers clinically to diagnose disease.
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Affiliation(s)
- Ping Lin
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Medical Microbiology and Parasitology, Fudan University School of Basic Medical Sciences, Shanghai, China
| | - Junyu Sun
- Department of Psychosis, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Xiaoyan Lou
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dan Li
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Shi
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenhua Li
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peijun Ma
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ping Li
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuzi Chen
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weifeng Jin
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuai Liu
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Chen
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Gao
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Zhu
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Xu
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengyuan Zhu
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengxia Wang
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kangyi Liang
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhao
- Department of Clinical Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huabin Xu
- Clinical Laboratory, Affiliated Hospital of West Anhui Health Vocational College, Lu’an, Anhui, China
| | - Ke Dong
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingtian Li
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xunjia Cheng
- Department of Medical Microbiology and Parasitology, Fudan University School of Basic Medical Sciences, Shanghai, China
| | - Jinghong Chen
- Editorial Office of General Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaokui Guo
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sharma R, Tikka SK, Yadav AK, Bhute AR, Dhamija P, Bastia BK. Cerebrospinal fluid monoamine metabolite concentrations in suicide attempt: A meta-analysis. Asian J Psychiatr 2021; 62:102711. [PMID: 34090249 DOI: 10.1016/j.ajp.2021.102711] [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: 02/18/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
AIM The purpose of this meta-analysis was to critically examine the data from individual studies on CSF neurotransmitter metabolites to see whether there were consistencies in the results of the comparison of suicide attempters and psychiatric controls and of the comparison of attempted suicides using violent versus nonviolent methods. METHOD Systematic literature search across different electronic databases using PubMed/Google Scholar/EMBASE/Cochrane library was conducted for studies that reported concentration of CSF-neurotransmitter metabolites: 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxy phenylglycol (MHPG) in suicide attempters, from January'1981 to November'2020. Standardized mean differences (SMDs) and corresponding 95 % confidence interval (CIs) were deduced for outcome measures. I2 statistics were used to assess heterogeneity within studies. Data were analyzed using STATA software. RESULTS A total of 36 studies (N = 1987 attempted suicide and N = 1235 psychiatry control) were included for the meta-analysis. We found CSF levels of all the 3 metabolites i.e. 5-HIAA (SMD= -0.43; 95 %CI: -0.61, -0.24), HVA (SMD= -0.16; 95 %CI: -0.33, -0.00) and MHPG (SMD= -0.33; 95 %CI: -0.71, -0.05) were lower in suicide attempters. While the findings were consistent for 5-HIAA, they were inconsistent for the HVA and MHPG. CSF levels of 5-HIAA (SMD= -0.66; 95 %; CI: -1.01, -0.31), HVA (SMD= -0.14; 95 %CI: -0.45, 0.16) and MHPG (SMD= -0.12; 95 %CI: -0.56, 0.31) were significantly lower in violent suicide attempters than non-violent attempters. No significant publication bias found in any study. CONCLUSION We found a significant association between lower levels of CSF 5-HIAA in suicide attempters, particularly the violent ones, compared to psychiatric controls, whereas findings from CSF HVA and MHPG were inconsistent.
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Affiliation(s)
- Rishi Sharma
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India.
| | - Sai Krishna Tikka
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Bibinagar, Hyderabad Metropolitan Region, Telangana, India
| | - Arun Kumar Yadav
- Department of Community Medicine, Armed Forces Medical College (AFMC) Pune, Maharashtra, India
| | - Ashish Ramesh Bhute
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India
| | - Puneet Dhamija
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India
| | - Binaya Kumar Bastia
- Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Uttarakhand, India
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Abstract
The lifetime risk of dying by suicide in schizophrenia and related psychoses has been estimated to be approximately between 5% and 7%, though some have estimated that the number is closer to 10%. The highest risk for suicide occurs within the first year after presentation, when patients have a 12 times greater risk of dying by suicide than the general population, or a 60% higher risk compared with patients in other phases of psychosis, although the risk continues for many years. Some 31% of all deaths in first and early episode samples are due to suicide. Studies in individuals at clinical high-risk for psychosis (CHR) or with attenuated positive symptoms also demonstrate that suicidality is common and problematic in these individuals. Therefore, suicide in psychosis is a particularly severe problem. In order to develop interventions aimed at reducing the risk of suicide in psychotic individuals, it will be critical to understand the neurobiology of suicide in psychosis. In this paper, I report on the results of a systematic review of the work done to date on the neurobiology of suicide in psychosis and on suicidality in the CHR period. I will also identify gaps in knowledge and discuss future strategies for studying the neurobiology of suicidality in psychosis that may help to disentangle the links between suicide and psychosis and, by doing so, allow us to gain a greater understanding of the relationship between suicide and psychosis, which is critical for developing interventions aimed at reducing the risk of suicide in psychotic individuals.
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Affiliation(s)
- Ragy R Girgis
- The New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY, USA
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Miller BJ, Parker CB, Rapaport MH, Buckley PF, McCall WV. Insomnia and suicidal ideation in nonaffective psychosis. Sleep 2020; 42:5165662. [PMID: 30407600 DOI: 10.1093/sleep/zsy215] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/20/2022] Open
Abstract
Study Objectives Insomnia is a common symptom in the clinical course of schizophrenia. There is a robust association between insomnia and suicidality in other psychiatric disorders. Two previous studies found associations between insomnia and suicide attempt or completed suicide in patients with schizophrenia. We hypothesized that greater insomnia would be associated with greater levels of suicidal ideation in patients with schizophrenia and other nonaffective psychoses. Methods We recruited 108 inpatients and outpatients age 18-65 between July 2010 and July 2016 with DSM-IV nonaffective psychosis (schizophrenia, schizoaffective disorder, or schizophreniform disorder). We investigated relationships between current insomnia (Insomnia Severity Index [ISI]), suicidal ideation over the past week, and lifetime history of suicide attempt (Beck Scale for Suicide Ideation [BSS]) in regression analyses. Results After controlling for potential confounders, insomnia was a significant indicator of suicidal ideation (β = 0.27, p = 0.032). Insomnia was also a significant indicator of a high BSS score (≥16; OR = 1.14, 95% CI: 1.01-1.28, p = 0.029). Furthermore, participants with severe insomnia were almost 15 times more likely to have a lifetime history suicide attempt than participants without current insomnia (OR = 14.8, 95% CI: 1.4-157, p = 0.025). Insomnia was also an indicator of greater PANSS total (β = 0.33, p = 0.001), positive subscale (β = 0.32, p = 0.002), and general subscale (β = 0.40, p < 0.001) scores. Conclusions Insomnia is associated with suicidal ideation, lifetime suicide attempt, and greater psychopathology in patients with schizophrenia. Our findings suggest that formal assessment of insomnia may be germane to the clinical care of patients with schizophrenia as a marker of suicide risk and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Carmen B Parker
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA
| | - Peter F Buckley
- School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
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Suicide in Schizophrenia: An Educational Overview. ACTA ACUST UNITED AC 2019; 55:medicina55070361. [PMID: 31295938 PMCID: PMC6681260 DOI: 10.3390/medicina55070361] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022]
Abstract
Suicide is an important public health problem. The most frequent psychiatric illnesses associated with suicide or severe suicide attempt are mood and psychotic disorders. The purpose of this paper is to provide an educational overview of suicidal behavior in individuals with schizophrenia. A lifetime suicide rate in individuals with schizophrenia is approximately 10%. Suicide is the largest contributor to the decreased life expectancy in individuals with schizophrenia. Demographic and psychosocial factors that increase a risk of suicide in individuals with schizophrenia include younger age, being male, being unmarried, living alone, being unemployed, being intelligent, being well-educated, good premorbid adjustment or functioning, having high personal expectations and hopes, having an understanding that life’s expectations and hopes are not likely to be met, having had recent (i.e., within past 3 months) life events, having poor work functioning, and having access to lethal means, such as firearms. Throughout the first decade of their disorder, patients with schizophrenia are at substantially elevated suicide risk, although they continue to be at elevated suicide risk during their lives with times of worsening or improvement. Having awareness of symptoms, especially, awareness of delusions, anhedonia, asociality, and blunted affect, having a negative feeling about, or non-adherence with, treatment are associated with greater suicide risk in patients with schizophrenia. Comorbid depression and a history of suicidal behavior are important contributors to suicide risk in patients with schizophrenia. The only reliable protective factor for suicide in patients with schizophrenia is provision of and compliance with comprehensive treatment. Prevention of suicidal behavior in schizophrenia should include recognizing patients at risk, delivering the best possible therapy for psychotic symptoms, and managing comorbid depression and substance misuse.
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Maurice-Gélinas C, Deslauriers J, Monpays C, Sarret P, Grignon S. The 5α-reductase inhibitor finasteride increases suicide-related aggressive behaviors and blocks clozapine-induced beneficial effects in an animal model of schizophrenia. Physiol Behav 2018; 191:65-72. [PMID: 29630964 DOI: 10.1016/j.physbeh.2018.03.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/14/2018] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
Death by suicide is 5 times higher among schizophrenia patients than in the general population. There is now compelling evidence suggesting that the pathophysiology of suicide in schizophrenia does not involve central serotonergic neurotransmission disturbances, as has been shown in other contexts. We recently developed and characterized a murine Two-Hit Model of Suicide-related behavior in a schizophrenia-like context (THMS) (gestational inflammation with polyI:C at gestational day 12 followed by post-weaning social isolation). In this THMS model, we have recently shown that the atypical antipsychotic clozapine normalized the prepulse inhibition (PPI) deficits as well suicide-related, impulsive aggressive and anxiety-like behaviors. While the mechanisms underlying the suicide-reducing benefits of clozapine in schizophrenic patients are not well understood, previous works have revealed that clozapine alters brain levels of neurosteroids, such as allopregnanolone. In the present study, we thus investigated the role of endogenous neurosteroids in clozapine action by evaluating whether the 5α-reductase inhibitor finasteride could overturn the ability of clozapine to reduce suicide-related behaviors. We found that clozapine significantly improved the PPI deficits in THMS mice, which could not be reversed by finasteride treatment. However, finasteride counteracted the ability of clozapine to decrease the exploratory behaviors in the open-field test. In the resident-intruder test, THMS mice showed exacerbated aggressiveness and impulsivity following finasteride alone. In this resident-intruder paradigm, clozapine alone effectively blocked the finasteride-enhanced effects on aggression and impulsivity. Altogether, these findings support the existence of a complex interaction between clozapine and neurosteroids in THMS mice. Further investigations are now required to clarify the details of the molecular mechanisms involved.
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Affiliation(s)
- Caroline Maurice-Gélinas
- Departement of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Jessica Deslauriers
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Center of Excellence for Stress and Mental Health, Veterans Affairs Hospital, La Jolla, CA, United States
| | - Cécile Monpays
- Departement of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Philippe Sarret
- Departement of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada
| | - Sylvain Grignon
- Departement of Pharmacology and Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada; Department of Psychiatry, Centre Hospitalier Universitaire de Sherbrooke, 580 Bowen Sud, Sherbrooke, QC J1G 2E8, Canada.
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Li J, Yoshikawa A, Meltzer HY. Replication of rs300774, a genetic biomarker near ACP1, associated with suicide attempts in patients with schizophrenia: Relation to brain cholesterol biosynthesis. J Psychiatr Res 2017; 94:54-61. [PMID: 28668716 DOI: 10.1016/j.jpsychires.2017.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 01/12/2023]
Abstract
The aim of this study was to determine if three biomarkers for suicide attempts previously identified and replicated in a genome-wide association (GWAS) study of bipolar disorder (BD) suicide attempters also predicted suicide attempts in patients prospectively diagnosed with schizophrenia (SCZ) or schizoaffective disorder (SAD). 162 genetically-verified Caucasian patients with SCZ or SAD were phenotyped for presence (45.7%) or absence of a lifetime suicide attempt. Three single nucleotide polymorphisms (SNPs) were genotyped or partially imputed from a GWAS dataset. After controlling for genetic architecture and gender, we replicated rs300774 (p = 0.012), near ACP1 (acid phosphatase 1), the top predictor of suicide attempts in the BD study. The result of Willour et al. (2012) was replicated in males (p = 0.046) but not in females (p = 0.205). The other two SNPs, rs7296262, and rs10437629, were not associated with suicide attempts in this study. rs300774 could be a cis-eQTL for ACP1, with minor allele carriers having lower expression levels (p = 0.002). This SNP also functioned as a trans-eQTL for genes related to cholesterol biosynthesis and the wnt-β-catenin pathway (p ≤ 0.0001). Further, co-expression analysis of candidate genes in brain suggested ACP1 is important to the regulation of a number of brain mechanisms linked to suicide, including cholesterol synthesis, β-catenin-mediated signaling pathway, serotonin, GABA, and the stress response via ARHGAP35 (p190rhogap), a repressor of glucocorticoid receptor (NR3C1) transcription. This study provides an additional validation of rs300774 as a potential transdiagnostic biomarker for suicide attempts and evidence that ACP1 may have an important role in regulation of the multiple systems associated with suicide.
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Affiliation(s)
- Jiang Li
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Akane Yoshikawa
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Herbert Y Meltzer
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States.
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Andreou D, Söderman E, Axelsson T, Sedvall GC, Terenius L, Agartz I, Jönsson EG. Associations between a locus downstream DRD1 gene and cerebrospinal fluid dopamine metabolite concentrations in psychosis. Neurosci Lett 2016; 619:126-30. [PMID: 26957229 DOI: 10.1016/j.neulet.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/13/2016] [Accepted: 03/02/2016] [Indexed: 02/07/2023]
Abstract
Dopamine activity, mediated by the catecholaminergic neurotransmitter dopamine, is prominent in the human brain and has been implicated in schizophrenia. Dopamine targets five different receptors and is then degraded to its major metabolite homovanillic acid (HVA). We hypothesized that genes encoding dopamine receptors may be associated with cerebrospinal fluid (CSF) HVA concentrations in patients with psychotic disorder. We searched for association between 67 single nucleotide polymorphisms (SNPs) in the five dopamine receptor genes i.e., DRD1, DRD2, DRD3, DRD4 and DRD5, and the CSF HVA concentrations in 74 patients with psychotic disorder. Nominally associated SNPs were also tested in 111 healthy controls. We identified a locus, located downstream DRD1 gene, where four SNPs, rs11747728, rs11742274, rs265974 and rs11747886, showed association with CSF HVA concentrations in psychotic patients. The associations between rs11747728, which is a regulatory region variant, and rs11742274 with HVA remained significant after correction for multiple testing. These associations were restricted to psychotic patients and were absent in healthy controls. The results suggest that the DRD1 gene is implicated in the pathophysiology of psychosis and support the dopamine hypothesis of schizophrenia.
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Affiliation(s)
- Dimitrios Andreou
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, Stockholm, Sweden.
| | - Erik Söderman
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Tomas Axelsson
- Department of Medical Sciences, Molecular Medicine, Uppsala University, Uppsala, Sweden
| | - Göran C Sedvall
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Lars Terenius
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, Stockholm, Sweden
| | - Ingrid Agartz
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, Stockholm, Sweden; NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erik G Jönsson
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, Stockholm, Sweden
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A two-hit model of suicide-trait-related behaviors in the context of a schizophrenia-like phenotype: Distinct effects of lithium chloride and clozapine. Physiol Behav 2016; 156:48-58. [DOI: 10.1016/j.physbeh.2016.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/18/2015] [Accepted: 01/05/2016] [Indexed: 01/30/2023]
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Abstract
Affective disorders such as anxiety, phobia and depression are a leading cause of disabilities worldwide. Monoamine neuromodulators are used to treat most of them, with variable degrees of efficacy. Here, we review and interpret experimental findings about the relation of neuromodulation and emotional feelings, in pursuit of two goals: (a) to improve the conceptualisation of affective/emotional states, and (b) to develop a descriptive model of basic emotional feelings related to the actions of neuromodulators. In this model, we hypothesize that specific neuromodulators are effective for basic emotions. The model can be helpful for mental health professionals to better understand the affective dynamics of persons and the actions of neuromodulators - and respective psychoactive drugs - on this dynamics.
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Affiliation(s)
- Fushun Wang
- Professor of Psychology, Director of the Institute of Emotional Psychology, Nanjing University of Traditional Medicine, 138 Xianlin Rd, Qixia district, Nanjing City, Jiangsu Province, China 210023. E-mail:
| | - Alfredo Pereira
- Adjunct Professor, Department of Education, São Paulo State University (UNESP), Campus of Rubião Jr, 18618-970 - Botucatu - São Paulo - Brasil
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Neider D, Lindström LH, Bodén R. Risk factors for suicide among patients with schizophrenia: a cohort study focused on cerebrospinal fluid levels of homovanillic acid and 5-hydroxyindoleacetic acid. Neuropsychiatr Dis Treat 2016; 12:1711-4. [PMID: 27468235 PMCID: PMC4946833 DOI: 10.2147/ndt.s107178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objective of this study was to investigate the association between 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF), bullying, and later suicide among patients with schizophrenia. METHODS Ninety-nine patients with schizophrenia were included. Correlations of clinical factors, 5-HIAA and HVA, and later suicide were investigated. RESULTS Twelve patients committed suicide (12%) during a 28-year follow-up period. Later suicide was correlated to bullying in childhood (P=0.02) and a lower quotient of HVA/5-HIAA in CSF (P<0.05). CONCLUSION Suicide in schizophrenia is related to childhood exposedness and CSF neurotransmitter levels.
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Affiliation(s)
- Daniel Neider
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Leif H Lindström
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
| | - Robert Bodén
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala University Hospital, Uppsala, Sweden
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12
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Zinchuk MS, Guekht AB, Gulyaeva NV, Avedisova AS, Akzhigitov RG, Grishkina MN. [Biological basis of suicidal behavior]. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [PMID: 28635744 DOI: 10.17116/jnevro20161168194-101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Based on current clinical and classification concepts of suicidality, the biological parameters characteristic of suicidal behavior, completed and uncompleted suicides reported in the last few decades are discussed. The results obtained in the studies of neurotransmitter and other brain systems, immune system, lipid and other types of metabolism as well as data of neuroimaging brain studies and post-mortem investigation of brain structures are presented.
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Affiliation(s)
- M S Zinchuk
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A B Guekht
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - N V Gulyaeva
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A S Avedisova
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - M N Grishkina
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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Karhumaa T, Hakko H, Nauha R, Räsänen P. Season of birth in suicides: excess of births during the summer among schizophrenic suicide victims. Neuropsychobiology 2014; 68:238-42. [PMID: 24280673 DOI: 10.1159/000355300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 08/26/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Season of birth is associated with several psychiatric disorders and suicidal behavior. We explored the association between the season of birth and suicide among schizophrenic and psychotic suicide victims. METHODS The study sample consisted of all suicides in the province of Oulu in Northern Finland from 1989 to 2010. Causes of death were extracted from death certificates, and psychiatric diagnoses associated with the hospital treatments were obtained from the Finnish Hospital Discharge Register. The seasons were defined as follows: winter (from November to January), spring (from February to April), summer (from May to July), and autumn (from August to October). Suicide victims (n = 1,902) were categorized as having either schizophrenia (n = 228) or psychosis other than schizophrenia (n = 240). Suicide victims without any hospital-treated mental disorder (n = 1,434) were used as a comparison group. RESULTS The distribution of births among suicide victims with schizophrenia differed statistically significantly from that observed in the general population, with a peak in summer (OR 1.2, 95% CI 1.0-1.5). CONCLUSIONS Birth during summer may predispose schizophrenic persons to suicide. The putative roles of serotonin, dopamine, and vitamin D status in the season of birth of psychotic suicide victims are discussed.
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Affiliation(s)
- Tuomo Karhumaa
- Department of Psychiatry, Institute of Clinical Medicine, University of Oulu, Oulu, Finland
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Ainiyet B, Rybakowski JK. Suicidal behavior in schizophrenia may be related to low lipid levels. Med Sci Monit 2014; 20:1486-90. [PMID: 25141886 PMCID: PMC4148359 DOI: 10.12659/msm.890884] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Lifetime suicide mortality in people with schizophrenia is approximately 4–5%, which is higher than in the general population. In mood disorders, many studies and meta-analyses have shown a link between suicidal behavior and low lipid levels, especially that of cholesterol, and some studies have also suggested such a relationship in schizophrenia. Therefore, the aim of the present study was to investigate a possible correlation between suicidal behavior and lipid levels in schizophrenia patients recently admitted to a psychiatric hospital. Material/Methods Our study included 148 (69 males, 79 females) schizophrenia patients with a mean age of 32±10 years, all recently admitted due to acute exacerbation of their mental illness. Psychometric and laboratory assessments were made within 24–72 hours after hospital admission. The main purpose of the interview was to assess occurrence of any suicidal thoughts, suicidal tendencies, and/or suicide attempts during the 3 months prior to admission. Serum total, LDL and HDL cholesterol, as well as triglycerides and total lipids were measured. Results A significant association was found between suicidal thoughts and attempts and low total cholesterol, LDL cholesterol, triglycerides, and total lipids, in both male and female patients. In male patients with suicidal tendencies, correlation with low LDL cholesterol and triglycerides did not reach statistical significance. No association with suicidality was found with HDL cholesterol in subjects studied. Conclusions The results obtained suggest that, similar to depressed patients, low total and LDL cholesterol, triglycerides, and total lipids can be state-dependent risk factors for suicidal behavior in Polish patients with schizophrenia.
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Affiliation(s)
- Babajohn Ainiyet
- Department of Psychiatry, Akerhus Universytetssykehus, Oslo, Norway
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland
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Andreou D, Söderman E, Axelsson T, Sedvall GC, Terenius L, Agartz I, Jönsson EG. Polymorphisms in genes implicated in dopamine, serotonin and noradrenalin metabolism suggest association with cerebrospinal fluid monoamine metabolite concentrations in psychosis. Behav Brain Funct 2014; 10:26. [PMID: 25073638 PMCID: PMC4123495 DOI: 10.1186/1744-9081-10-26] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/14/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) are the major monoamine metabolites in the central nervous system (CNS). Their cerebrospinal fluid (CSF) concentrations, reflecting the monoamine turnover rates in CNS, are partially under genetic influence and have been associated with schizophrenia. We have hypothesized that CSF monoamine metabolite concentrations represent intermediate steps between single nucleotide polymorphisms (SNPs) in genes implicated in monoaminergic pathways and psychosis. METHODS We have searched for association between 119 SNPs in genes implicated in monoaminergic pathways [tryptophan hydroxylase 1 (TPH1), TPH2, tyrosine hydroxylase (TH), DOPA decarboxylase (DDC), dopamine beta-hydroxylase (DBH), catechol-O-methyltransferase (COMT), monoamine oxidase A (MAOA) and MAOB] and monoamine metabolite concentrations in CSF in 74 patients with psychotic disorder. RESULTS There were 42 nominally significant associations between SNPs and CSF monoamine metabolite concentrations, which exceeded the expected number (20) of nominal associations given the total number of tests performed. The strongest association (p = 0.0004) was found between MAOB rs5905512, a SNP previously reported to be associated with schizophrenia in men, and MHPG concentrations in men with psychotic disorder. Further analyses in 111 healthy individuals revealed that 41 of the 42 nominal associations were restricted to patients with psychosis and were absent in healthy controls. CONCLUSIONS The present study suggests that altered monoamine turnover rates in CNS reflect intermediate steps in the associations between SNPs and psychosis.
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Affiliation(s)
- Dimitrios Andreou
- Department of Clinical Neuroscience, Psychiatry Section, HUBIN Project, Karolinska Institutet and Hospital, R5:00, SE-171 76 Stockholm, Sweden.
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Melle I, Ann Barrett E. Insight and suicidal behavior in first-episode schizophrenia. Expert Rev Neurother 2014; 12:353-9. [DOI: 10.1586/ern.11.191] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Carlborg A, Jokinen J, Nordström AL, Jönsson EG, Nordström P. Early death and CSF monoamine metabolites in schizophrenia spectrum psychosis. Nord J Psychiatry 2011; 65:101-5. [PMID: 20662686 DOI: 10.3109/08039488.2010.503903] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Patients with schizophrenia have higher rates of mortality than the general population. Lower concentrations of the cerebrospinal fluid (CSF) monoamine metabolites homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) have been associated with suicidal, aggressive and impulsive behavior. Mortality has been suggested as a measure of impulsivity and a relationship between early death and lower concentrations of CSF monoamine metabolites has been reported but the studies are few with short periods of follow-up and small numbers. AIM The objective of this study was to investigate a relationship between early death and concentrations of CSF 5-HIAA and HVA. METHODS Three hundred and eighty-five inpatients with schizophrenia spectrum psychosis were lumbar punctured in a standardized manner and followed for a median of 26 years. Patients were searched to identify those who had died. Causes of death were obtained from the Causes of Death Register. RESULTS During the time of follow-up, 97 patients died. Schizophrenia spectrum psychosis patients died at an earlier age from both natural and unnatural causes of death. No significant associations were found between CSF 5-HIAA and HVA concentrations and non-suicidal death. Attempted suicide was not a risk factor for non-suicidal death at younger age. CONCLUSION Patients with schizophrenia spectrum psychosis die at an earlier age from both natural and unnatural causes of death. Attempted suicide is not a risk factor for non-suicidal death at younger age. Low concentrations of CSF HVA and 5-HIAA were not a risk factor for non-suicidal death at younger age in schizophrenia spectrum psychosis.
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Affiliation(s)
- Andreas Carlborg
- Department of Clinical Neuroscience, Psychiatry, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
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18
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Andreou D, Saetre P, Werge T, Andreassen OA, Agartz I, Sedvall GC, Hall H, Terenius L, Jönsson EG. Tryptophan hydroxylase gene 1 (TPH1) variants associated with cerebrospinal fluid 5-hydroxyindole acetic acid and homovanillic acid concentrations in healthy volunteers. Psychiatry Res 2010; 180:63-7. [PMID: 20580984 DOI: 10.1016/j.psychres.2009.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 11/06/2009] [Accepted: 11/16/2009] [Indexed: 10/19/2022]
Abstract
Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in serotonin synthesis. We investigated possible relationships between five TPH1 gene polymorphisms and cerebrospinal fluid (CSF) concentrations of the major serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), the major dopamine metabolite homovanillic acid (HVA), and the major norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) in healthy volunteers (n=132). The G-allele of the TPH1 rs4537731 (A-6526G) polymorphism was associated with 5-HIAA and HVA, but not MHPG concentrations. None of the other four TPH1 polymorphisms (rs211105, rs1800532, rs1799913 and rs7933505) were significantly associated with any of the monoamine metabolite concentrations. Two (rs4537731G/rs211105T/rs1800532C/rs1799913C/rs7933505G and rs4537731A/rs211105T/rs1800532C/rs1799913C/rs7933505G) of five common TPH1 five-allele haplotypes were associated with 5-HIAA and HVA concentrations in opposite directions. None of the common haplotypes was associated with MHPG concentrations in the CSF. The results suggest that TPH1 gene variation participates in the regulation of serotonin and dopamine turnover rates in the central nervous system of healthy human subjects.
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Affiliation(s)
- Dimitrios Andreou
- Department of Clinical Neuroscience, HUBIN project, Karolinska Institutet and Hospital, R5:00, SE-171 76 Stockholm, Sweden
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Souza RP, De Luca V, Manchia M, Kennedy JL. Are serotonin 3A and 3B receptor genes associated with suicidal behavior in schizophrenia subjects? Neurosci Lett 2010; 489:137-41. [PMID: 21184810 DOI: 10.1016/j.neulet.2010.11.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/13/2010] [Accepted: 11/30/2010] [Indexed: 01/16/2023]
Abstract
Suicide is a major contributor to the morbidity and mortality of schizophrenia, accounting for approximately 10% of deaths in these patients. Genetic factors have been reported to modulate the risk for suicide, although the precise mechanism and magnitude of the genetic contribution are unknown. Further, suicide attempters present abnormalities in the serotonergic system. We evaluated whether genetic variants in the serotonin receptors HTR3A (rs897692, rs1150226, rs1176724, rs2276302, rs3737457, rs897687 and rs1176713) and HTR3B (rs3758987, rs10502180, rs11606194, rs17116121, rs1176744, rs17116138, rs2276307, rs3782025 and rs1176761) were susceptibility components for suicidal behavior in 154 Caucasians schizophrenia subjects (20.1% of suicide attempters). In a second step, we compared haplotype and gene-gene interaction approaches because both genes are located in the chromosome 11q23 approximately 28Kbp apart. We did not observe allelic or genotypic associations. Six haplotypes were nominally significant associated with suicide. Gene-gene interaction using Helix Tree software showed two nominally significant interactions reproduced by haplotype association. Likewise, haplotypes composed by the markers included in the best multidimensional reduction three-locus model were nominally significant. Our results suggest that HTR3A and HTR3B polymorphisms may not play a major role in the susceptibility for suicidal behavior in schizophrenia subjects. Moreover, gene-gene interaction and haplotype association may have consistent results for genes located in the same chromosome.
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Affiliation(s)
- Renan P Souza
- Neurogenetics Section, Neuroscience Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Abstract
Risk assessment is a core skill in psychiatry. Risk prediction for suicide in schizophrenia is known to be complex. We undertook a systematic review of all original studies concerning suicide in schizophrenia published since 2004. We found 51 data-containing studies (from 1281 studies screened) that met our inclusion criteria, and ranked these by standardized quality criteria. Estimates of rates of suicide and risk factors associated with later suicide were identified, and the risk factors were grouped according to type and strength of association with suicide. Consensus on the lifetime risk of suicide was a rate of approximately 5%. Risk factors with a strong association with later suicide included being young, male, and with a high level of education. Illness-related risk factors were important predictors, with number of prior suicide attempts, depressive symptoms, active hallucinations and delusions, and the presence of insight all having a strong evidential basis. A family history of suicide, and comorbid substance misuse were also positively associated with later suicide. The only consistent protective factor for suicide was delivery of and adherence to effective treatment. Prevention of suicide in schizophrenia will rely on identifying those individuals at risk, and treating comorbid depression and substance misuse, as well as providing best available treatment for psychotic symptoms.
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Affiliation(s)
| | - Mark Taylor
- Dr Taylor, Ballenden House, 28 Howden St, Edinburgh EH8 9HL, UK
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Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother 2010; 10:1153-64. [PMID: 20586695 DOI: 10.1586/ern.10.82] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Schizophrenia is a disorder with an estimated suicide risk of 4-5%. Many factors are involved in the suicidal process, some of which are different from those in the general population. Clinical risk factors include attempted suicide, depression, male gender, substance abuse and hopelessness. Biosocial factors, such as a high intelligence quotient and high level of premorbid function, have also been associated with an increased risk of suicide in patients with schizophrenia. Suicide risk is especially high during the first year after diagnosis. Many of the suicides occur during hospital admission or soon after discharge. Management of suicide risk includes both medical treatment and psychosocial interventions. Still, risk factors are crude; efforts to predict individual suicides have not proved useful and more research is needed.
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