Serum cholesterol, suicidal tendencies, impulsivity, aggression, and depression in adolescent psychiatric inpatients

A new perspective on cholesterol in pediatric health: association of vitamin D metabolism, respiratory diseases, and mental health problems

Cholesterol, the main structural molecule of cell membranes, is involved in essential functions of the human body. Dyslipidemia is an established risk factor for cardiovascular diseases (CVDs) that is observed even in childhood. To reduce the risk of CVDs in children, several clinical guidelines have been published for the management of pediatric dyslipidemia. However, pediatric dyslipidemia is also associated with several health problems other than CVDs. This article reviews the current data on dyslipidemia-related pediatric health issues. There is strong evidence that low serum vitamin D levels, asthma, and mental health problems may be associated with dyslipidemia in the pediatric population regardless of body mass index. This review also highlights the need for further large-scale population-based studies in the Korean pediatric population to establish effective strategies for promoting children's health.

Serum Lipid Levels and Suicide Attempts Within 2 Weeks in Patients With Major Depressive Disorder: Is There a Relationship?

The potential correlation between serum lipid profiles and suicidal tendencies has been previously reported, however, it is unclear whether serum lipid profiles have definite relevance to recently attempted suicides in individuals suffering from major depressive disorder (MDD). In this study, the relationship between blood lipids and suicide attempts in first-episode MDD patients in research were used to examine whether there is a connection. The cross-sectional study recruited 580 patients at the time of their first episode, measuring up to the diagnostic standard of MDD. Baseline demographic, clinical data, and blood lipid level data were collected. Depression severity was measured with the Hamilton Depression Rating Scale (HAMD). Our results revealed that the level of TC may be identified as a promising and effective biomarker for first-episode MDD suicide risk, suggesting that screening of serum lipid profiles in depressive patients is essential for suicide prevention.

Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders

OBJECTIVE

Low total cholesterol has been linked with adverse mental symptoms such as aggression and impulsivity in severe mental disorders (SMDs). This putative association may affect the clinician's decision making about cholesterol lowering in this patient group. Here, we investigated the associations between cholesterol levels, aggression, and impulsivity in a large representative sample of in- and outpatients with SMD.

METHODS

Patients with schizophrenia- or bipolar spectrum disorders (N = 1 001) underwent thorough clinical characterization and blood sampling (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol). Aggression was characterized by the Positive and Negative Syndrome Scale Excited Component. Impulsivity was measured with the Barratt Impulsiveness Scale in a subsample of patients (N = 288). We used a multinomial logistic regression model to analyze the association between cholesterol and aggression and a multiple linear regression model to analyze the association between cholesterol and impulsivity, while controlling for confounders.

RESULTS

We found no significant associations between cholesterol levels and aggression or impulsivity. There were no significant interactions between cholesterol and diagnostic group or inpatient versus outpatient status. Controlling for medication use, body mass index, alcohol or illicit substance use did not affect the results.

CONCLUSION

In this large sample of patients with schizophrenia- and bipolar spectrum disorders, we found no associations between cholesterol levels and aggression or impulsivity. This has clinical implications as patients with SMD are at increased CVD risk and currently undertreated with statins.

Low cholesterol levels in children predict impulsivity in young adulthood

OBJECTIVE

Severe behavioural issues such as impulsive action and suicide have since long been associated with low levels of cholesterol. While it is known that cholesterol plays a role in neural development and hence low levels of serum lipids could have long-term effects on behaviour, no longitudinal studies showed the association of serum lipids levels with impulsivity. We aimed to examine the prognostic properties of serum lipid levels during childhood and adolescence on measures of impulsivity during early adulthood in a representative birth cohort sample.

METHODS

We have investigated whether serum lipid levels measured at 9, 15, 18 and 25 years of age have an association with impulsivity in 25 years old young adults. This analysis was based on data of the birth cohort representative samples of the Estonian Children Personality Behaviour and Health Study (original n = 1238). Impulsivity was self-reported with the Adaptive and Maladaptive Impulsivity Scale.

RESULTS

Total and low-density lipoprotein (LDL) cholesterol measured in boys aged 9, 15 and 18 years predicted disinhibition and thoughtlessness in 25-year-old young adults. High scores of disinhibition were associated with low total and LDL cholesterol levels in males but, while less consistently, with high total and LDL cholesterol levels in females. Cross-sectional analysis did not result in systematic outcomes.

CONCLUSIONS

Serum lipid levels could have an impact on the development of Maladaptive Impulsivity starting from an early age. This effect of cholesterol continues throughout adolescence into young adulthood.

The Association between Depressive Mood and Cholesterol Levels in Korean Adolescents

OBJECTIVE

Previous studies have shown that there is a correlation between lipid levels and depressive mood, and that lipids could be useful biomarkers for depression. We conducted this study to clarify the association between lipid levels and depressive mood in adolescents, especially in community samples.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) that was conducted from 2013 to 2016. A total of 2,454 adolescents aged 12-18 years (1,273 boys, 1,181 girls) participated in the Survey. We conducted a cross-sectional study using multiple logistic regression, adjusting for age, household income, daily energy intake, daily fat intake, and daily cholesterol intake, to assess the association between depressive mood and serum lipid levels.

RESULTS

Depressive mood was found in 8.7% of those included in the study. Borderline (110-129 mg/dL) and high (≥130 mg/dL) levels of low-density lipoprotein cholesterol (LDL-C) were significantly associated with depressive mood [Borderline level: odds ratio (OR)=5.55, 95% confidence interval (CI) 1.56-19.81, p=0.01; High level: OR=5.73, 95% CI 1.06-31.08, p=0.04]. However, this association was not found in girls.

CONCLUSION

Our findings indicate that depressive mood in boys is associated with higher LDL-C levels. Further investigation regarding this relationship and the underlying biological mechanisms is needed.

Hypocholesterolemia is an independent risk factor for depression disorder and suicide attempt in Northern Mexican population

BACKGROUND

Cholesterol has been associated as a risk factor for cardiovascular disease. Recently, however, there is growing evidence about crucial requirement of neuron membrane cholesterol in the organization and function of the 5-HT_1A serotonin receptor. For this, low cholesterol level has been reported to be associated with depression and suicidality. However there have been inconsistent reports about this finding and the exact relationship between these factors remains controversial. Therefore, we investigated the link between serum cholesterol and its fractions with depression disorder and suicide attempt in 467 adult subjects in Mexican mestizo population.

METHODS

Plasma levels of total cholesterol, triglycerides, and high-density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) were determined in 261 MDD patients meeting the DSM-5 criteria for major depressive disorder (MDD), 59 of whom had undergone an episode of suicide attempt, and 206 healthy controls.

RESULTS

A significant decrease in total cholesterol, LDL-cholesterol, VLDL-cholesterol and triglyceride serum levels was observed in the groups of MDD patients and suicide attempt compared to those without suicidal behavior (p < 0.05). After adjusting for covariates, lower cholesterol levels were significantly associated with MDD (OR 4.229 CI 95% 2.555 - 7.000, p<.001) and suicide attempt (OR 5.540 CI 95% 2.825 - 10.866, p<.001) CONCLUSIONS: These results support the hypothesis that lower levels of cholesterol are associated with mood disorders like MDD and suicidal behavior. More mechanistic studies are needed to further explain this association.

Is There a Link Between Cholesterol Level and the Risk of Developing Depression?

Depressive disorders and hypercholesterolemia are serious and common global problems. Many researchers have attempted to demonstrate association between concentration of the lipid fractions, depression as well as the rate of suicide, but the results are inconclusive. To overcome this lack of knowledge, we have summarized the studies concerning this relationship and published in recent years. All of articles included were published in peer reviewed journals and were identified through systematic query of PubMed with follow-up manual searches.

Concentrations of total cholesterol – TC, cholesterol – LDL-C, cholesterol - HDL-C other triglycerides and others atherogenic index and comorbidity with depressive disorders have been considered. While both positive and negative association between lipid fractions and depression have been shown in many studies, some data revealed no relationships between the two factors. In addition, we have also summarized the usage of statins and the occurrence of depressive disorders, and the results remain inconclusive.

In conclusion, our review did not reveal a clear relationship between lipid fractions and depression. Additional studies are needed as increased incidence of comorbidity between mood disorders and lipid disorders have been observed.

The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: a systematic review

BACKGROUND

Mood and anxiety disorders are leading causes of disability and mortality, due largely to their onset during adolescence and young adulthood and broader impact on functioning. Key factors that are associated with disability and these disorders in young people are social and economic participation (e.g. education, employment), physical health, suicide and self-harm behaviours, and alcohol and substance use. A better understanding of the objective markers (i.e. neurobiological parameters) associated with these factors is important for the development of effective early interventions that reduce the impact of disability and illness persistence.

METHODS

We systematically reviewed the literature for neurobiological parameters (i.e. neuropsychology, neuroimaging, sleep-wake and circadian biology, neurophysiology and metabolic measures) associated with functional domains in young people (12 to 30 years) with mood and/or anxiety disorders.

RESULTS

Of the one hundred and thirty-four studies selected, 7.6 % investigated social and economic participation, 2.1 % physical health, 15.3 % suicide and self-harm behaviours, 6.9 % alcohol and substance use, whereas the majority (68.1 %) focussed on clinical syndrome.

CONCLUSIONS

Despite the predominance of studies that solely examine the clinical syndrome of young people the literature also provides evidence of distinct associations among objective measures (indexing various aspects of brain circuitry) and other functional domains. We suggest that a shift in focus towards characterising the mechanisms that underlie and/or mediate multiple functional domains will optimise personalised interventions and improve illness trajectories.

Serum lipid levels and suicidality: a meta-analysis of 65 epidemiological studies

BACKGROUND

We conducted a systematic review and meta-analysis to determine the association between serum lipid levels and suicidality, as evidence from previous studies has been inconsistent.

METHODS

We identified relevant studies by searching Medline, Web of Science, EMBASE, and the Cochrane Database of Systematic Reviews (1980 to Dec. 5, 2014). Studies assessing the association between serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) levels and suicidality were included. We used a random-effects model to take into account heterogeneity among studies.

RESULTS

We included 65 studies with a total of 510 392 participants in our analysis. Compared with the nonsuicidal patients, suicidal patients had significantly lower serum TC (weighted mean difference [WMD] -22.35, 95% confidence interval [CI] -27.95 to -16.75), LDL-C (WMD -19.56, 95% CI -26.13 to -12.99) and TG (WMD -23.40, 95% CI -32.38 to -14.42) levels, while compared with the healthy controls, suicidal patients had significantly lower TC (WMD -24.75, 95% CI -27.71 to -21.78), HDL-C (WMD -1.75, 95% CI -3.01 to -0.48) and LDL-C (WMD -3.85, 95% CI -7.45 to -0.26) levels. Furthermore, compared with the highest serum TC level category, a lower serum TC level was associated with a 112% (95% CI 40%-220%) higher risk of suicidality, including a 123% (95% CI 24%-302%) higher risk of suicide attempt and an 85% (95 CI 7%-221%) higher risk of suicide completion. The cut-off values for low and high serum TC level were in compliance with the categories reported in the original studies.

LIMITATIONS

A major limitation of our study is the potential heterogeneity in most of the analyses. In addition, the suicidal behaviour was examined using different scales or methods across studies, which may further explain heterogeneity among the studies.

CONCLUSION

We identified an inverse association between serum lipid levels and suicidality. More mechanistic studies are needed to further explain this association.

Autoantibodies are not Predictive Markers for the Development of Depressive Symptoms in a Population-Based Cohort of Older Adults

Background

Autoantibodies have been implicated in the etiologic pathway of depressive disorders. Here, we determine the association between the presence of a panel of autoantibodies at baseline and change in depression symptom score over 5-year follow-up in a cohort of healthy elderly Australians.

Methods

Serum samples from 2049 randomly selected subjects enrolled in the Hunter Community Study (HCS) aged 55–85 years were assayed for a range of autoimmune markers (anti-nuclear autoantibodies, extractable nuclear antigen autoantibodies, anti-neutrophil cytoplasmic autoantibodies, thyroid peroxidase autoantibodies, tissue transglutaminase autoantibodies, anti-cardiolipin autoantibodies, rheumatoid factor and cyclic citrullinated peptide autoantibodies) at baseline. Depression symptom score was assessed using the Centre for Epidemiological Study (CES-D) scale at baseline and 5 years later.

Results

Autoantibody prevalence varied amongst our sample with ANA being the most prevalent; positive in 16% and borderline in 36% of study population. No evidence for a relationship was found between change in CES-D score over time and any autoimmune marker. Statins and high cholesterol were significantly associated with change in CES-D score over time in univariate analysis; however, these were probably confounded since they failed to remain significant following multivariable analysis.

Conclusions

Autoantibodies were not associated with change in CES-D score over time. These findings point to an absence of autoimmune mechanisms in the general population or in moderate cases of depression.

The co-occurrence of aggression and self-harm: systematic literature review

BACKGROUND

Epidemiological research supports an association between aggression and self-harm through data on the frequency with which individuals exhibit both behaviours. Unbiased evidence, however, is needed to draw conclusions about the nature and extent of co-occurrence.

METHOD

Systematic review of published studies was undertaken to evaluate whether or not the frequency with which aggression and self-harm co-occur is beyond that which would be expected by chance. Outcome measures included: (a) between-group differences on a standardised aggression/self-harm measure - the groups defined by scores on a measure of the other behaviour; (b) correlations between the two behaviours; (c) co-occurrence rates in populations defined by the presence of either behaviour; (d) co-occurrence rates in populations not defined by either behaviour. Odds ratios were calculated for studies presenting complete frequency data.

RESULTS

123 studies, some yielding more than one type of result, met the inclusion criteria. Most case-control studies found elevated levels of aggression in self-harming populations (or self-harm in aggressive populations) compared to controls. The majority of correlational, co-occurrence rate, and odds ratio data found aggression and self-harm to be associated.

LIMITATIONS

Results were subject to descriptive synthesis only and thus, unable to report an overall effect size.

CONCLUSIONS

Evidence suggests that aggression and self-harm frequently co-occur. Such evidence necessitates more theoretical discussion and associated research on the source and nature of co-occurrence. Nonetheless, individuals who present with one behaviour may be considered an 'at-risk' group in terms of exhibiting the other. Such evidence holds implications for practice (e.g. risk assessment).

Higher total cholesterol level is associated with suicidal ideation in first-episode schizophrenia females

There are inconsistent reports showing that the relationship between total cholesterol (TC) level and suicidality might be gender-specific. We compared 30 first-episode schizophrenia (FES) patients reporting suicidal ideation based on the Operational Criteria for Psychotic Illness (OPCRIT) checklist with 70 FES patients, who have never experienced suicidal ideation. After controlling for potential confounders, higher TC was associated with suicidal ideation only in FES females. Future studies should disentangle biological underpinnings of this gender-specific association.

Potential neurochemical links between cholesterol and suicidal behavior

The role of cholesterol in psychiatric diseases has aroused the interest of the medical community, particularly in association with violent and suicidal behavior. Herein, we discuss some aspects of brain cholesterol metabolism, exploring possible mechanisms underlying the findings and reviewing the available literature on the possible neurochemical link between suicide and low or reduced levels of serum cholesterol. Most of the current hypotheses suggest a decreased serotonergic activity due to a decrease in cholesterol in the lipid rafts of synaptic membranes. Some aspects and limitations of this assumption are emphasized. In addition to serotonin hypofunction, other mechanisms have been proposed to explain increased impulsivity in suicidal individuals, including steroid modulation and brain-derived neurotrophic factor decrease, which could also be related to changes in lipid rafts. Other putative markers of suicidal behavior (e.g. protein S100B) are discussed in connection with cholesterol metabolism in the brain tissue.

A genetically informed test of cholesterol levels and self-control, depressive symptoms, antisocial behavior, and neuroticism

BACKGROUND

Low cholesterol levels have been found to be associated with a wide range of behavioral problems, including violent and criminal behavior, and a wide range of psychological problems including impulsivity, depression, and other internalizing problems. The casual mechanisms underlying these associations remain largely unknown, but genetic factors may play a role in the etiology of such associations as previous research has found significant genetic influence on cholesterol levels and various deleterious behavioral and psychological outcomes. The current study addressed this existing gap in the literature by performing a genetically sensitive test of the association between cholesterol levels and various outcomes including levels of self-control, depressive symptoms, anger expression, and neuroticism.

METHODS

DeFries-Fulker (DF) analysis was used to analyze data from 388 twin pairs nested within the Survey of Midlife Development in the United States (MIDUS).

RESULTS

The results of the genetically informed models revealed that high-density lipoprotein (HDL) cholesterol levels were negatively and significantly associated with depressive symptoms, had a marginally significant effect on neuroticism, and a nonsignificant effect on both anger expression and self-control.

LIMITATIONS

The findings may not extrapolate to the larger population of American adults since the subsample of twins with cholesterol information may not be nationally representative.

CONCLUSIONS

Genetic influences play a significant role in the association between cholesterol levels and various deleterious outcomes and failing to control for these influences may result in model misspecification and may increase the probability of detecting a significant association when one does not actually exist.

Impulsivity in remitted depression: a meta-analytical review

AIM

Depressive disorder and suicide have been associated with impulsivity in several studies. This paper aimed to review measures of trait impulsivity in remitted depressive disorder.

METHODS

We used keywords "impulsivity and depression"; "impulsivity and depressive disorder" to narrow down our search on Medline, EMBASE and Psychinfo to include those studies that had reported impulsivity scores using validated and reliable assessment measures in remitted depressive disorder. We searched all English language studies from 1990 to December 2012 with 9 reports meeting the inclusion criteria for depression, which were then reviewed by the two reviewers independently. We generated weighted mean differences (WMDs) for depression from the pooled data using RevManager 5.1 from Cochrane analysis.

RESULTS

The Barratt Impulsivity Scale (BIS) 11 was the instrument commonly used in depression. 9 studies met inclusion criteria in depression, which yielded a WMD of 10.12 on BIS 11 total scores.

CONCLUSION

There is a strong association of impulsivity and depression, which persists even in remission.

A controlled study of serum lipid profiles in Indian patients with depressive episode

BACKGROUND

Lower levels of circulating lipid fractions and cholesterol are risk factors for impulsivity and depressive disorder. A lower level of serum cholesterol is also associated with patients presenting with history of self-harm.

MATERIALS AND METHODS

A total of 30 depressive patients and 30 healthy matched control subjects were recruited from the department of Psychiatry of a tertiary care hospital. We measured serum total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein cholesterol and triglyceride levels of both patient and control group.

RESULTS

The serum TC and LDL-cholesterol levels were found to be significantly lower in study group than that of control group.

CONCLUSION

Lower levels of serum cholesterol are associated with depressive disorder.

Metabolic profiles in adults with autism spectrum disorder and intellectual disabilities

INTRODUCTION

Low levels of blood cholesterol have been found in some children with autism spectrum disorders (ASD). Psychotropic medications, commonly used by people with ASD and people with intellectual disabilities (ID) are frequently associated with altered metabolic profiles.

PURPOSE

We aimed to compare metabolic features of adults with ASD or ID with those of a community-based population.

SUBJECTS AND METHODS

Data on blood fasting glucose (FBG), lipid profile, liver enzyme profile, TSH, BMI, medications and diagnoses of 80 adults with ASD, 77 adults with ID and 828 control adults were drawn from medical charts/database. Candidates that used glucose or lipid lowering medications were not included.

RESULTS

Total-cholesterol levels of people with ASD and ID were significantly lower than those of the controls (168.3 ± 32.78, 168.2 ± 32.91, 185.4 ± 40.49 mg/dL, respectively, P<0.001) but after adjusting for gender, age and BMI and using Bonferroni correction, the significance was lost. Compared to controls, ASD and ID had significantly lower FBG (by -14.45 ± 1.81, -14.58 ± 1.54 mg/dl, respectively; P<0.001 for both) and liver enzymes, despite using psychotropic medications.

DISCUSSION AND CONCLUSION

In contrast to other psychiatric patients receiving similar medications, people with ASD and ID have unaltered lipid profiles and lower glucose and liver enzyme levels compared to a community-based population.

The Relationships between Cholesterol and Suicide: An Update

Cholesterol is a core component of the central nervous system, essential for the cell membrane stability and the correct functioning of neurotransmission. It has been observed that cholesterol may be somewhat associated with suicidal behaviours. Therefore, the aim of this paper was to elucidate current facts and views about the role of cholesterol levels in mood disorders. The majority of the studies reviewed in the present paper suggest an interesting relationship between cholesterol (especially lower levels) and suicidality. On the other hand, particularly during the last years, relationships between serum cholesterol and suicidality were doubted on the basis of some recent studies that have not found any correlation. However, the debate on relationships between cholesterol and suicide is open and longitudinal studies on a larger sample of patients are needed to further clarify this important issue.

Total serum cholesterol levels and suicide attempts in child and adolescent psychiatric inpatients

Associations between cholesterol and suicidal behavior in adolescent patients have not been explored in depth. In this study, 66 patients consecutively admitted to a psychiatric inpatient unit following attempted suicide were compared with a control group of 54 patients with no history of suicide attempts. The age range of the sample was from 8 to 18 years old. Cholesterol levels were significantly lower in attempted suicide patients than in controls (p < 0.02), supporting the hypothesis that lower cholesterol levels might be associated with suicidal behavior in patients with similar acute phase of their disorder.

Suicide neurobiology

In this review, we examine the history of the neurobiology of suicide, as well as the genetics, molecular and neurochemical findings in suicide research. Our analysis begins with a summary of family, twin, and adoption studies, which provide support for the investigation of genetic variation in suicide risk. This leads to an overview of neurochemical findings restricted to neurotransmitters and their receptors, including recent findings in whole genome gene expression studies. Next, we look at recent studies investigating lipid metabolism, cell signalling with a particular emphasis on growth factors, stress systems with a focus on the role of polyamines, and finally, glial cell pathology in suicide. We conclude with a description of new ideas to study the neurobiology of suicide, including subject-specific analysis, protein modification assessment, neuroarchitecture studies, and study design strategies to investigate the complex suicide phenotype.

Are cholesterol and depression inversely related? A meta-analysis of the association between two cardiac risk factors

BACKGROUND

Cholesterol and depression are both cardiac risk factors, but the direction and magnitude of the association between these risk factors is unclear.

PURPOSE

Meta-analytic techniques were used to evaluate the associations among total, high-, and low-density cholesterol (TC, HDL, LDL, respectively) and depression in empirical studies.

METHODS

PubMed, CINAHL, PsycINFO, and manual search strategies were used to identify descriptive studies reporting associations among TC, HDL, LDL, and depression; 30 reports were found for TC, 16 for HDL, and 11 for LDL. Effect sizes were computed and aggregated in accord with Hedges and Olkin's (Statistical methods for meta-analysis. New York: Academic Press; 1985) procedures.

RESULTS

Higher TC was associated with lower levels of depression, d = -0.29; this association was substantially larger among medication-free samples (d = -0.51). An inverse, non-significant association was observed between LDL and depression (d = -0.17). High HDL was related to higher levels of depression, especially in women (d = 0.20).

CONCLUSIONS

TC and depression were inversely related, with the strongest associations in medically naïve samples, which is noteworthy because such samples should involve fewer confounds. One clinical implication is that the lipids of patients treated for depression should be monitored.

Changes in plasma cholesterol in mood disorder patients: does treatment make a difference?

OBJECTIVES

To examine the impact of treatment in patients with acute episodes of major depressive (MD) and manic or hypomanic (M/HM) episodes and co-morbid generalized anxiety symptoms, on the total cholesterol blood levels (TC).

METHOD

A consenting series of patients with acute episodes of DSM IV-R confirmed diagnosis of MD or M/H were included. Subjects were treated with antidepressants, mood stabilizers, or both. The Hamilton depression scale (HAM-D21), the modified mania rating scale (MMRS), and the Hamilton anxiety scale (HAM-A) were utilized to evaluate clinical symptoms. Blood samples were drawn for TC estimations after 10 h of fasting on two occasions over time. The first sample was taken before treatment was started, and the second 4 weeks after treatment. The relationship between changes in TC and the severity of psychiatric symptoms, as measured on HAM-D, MMRS, and the HAM-A, were analysed.

RESULTS

56 subjects (34 with MD and 22 with M/HM episodes) completed the study. About 4 weeks after treatment there was a statistically significant increase in the TC in patients with MD versus a significant decrease in patients with M/HM episodes.

CONCLUSION

Our results replicate earlier reports of significant increase in the cholesterol levels in depressed patients after treatment. We report a significant decrease of TC levels in M/HM episodes with treatment. Although the results in previous reports and in our study are statistically significant, their clinical significance requires further examination in longer-term studies.

Oxidation of apolipoprotein B-containing lipoproteins and serum paraoxonase/arylesterase activities in major depressive disorder

Major depressive disorder (MDD) is blaimed to play a role in the onset of coronary artery disease (CAD). The aim of the present study was to investigate serum paraoxonase/arylesterase activities and oxidation of apolipoprotein B-containing lipoproteins in patients with MDD. Oxidation of lipoproteins plays an important role in atherogenesis and the enzyme paraoxonase, has been shown to prevent lipoprotein oxidation. Furthermore, low paraoxonase activity was suggested to predict CAD. Eighty-six patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for MDD and 36 healthy control subjects were included in the study. Serum paraoxonase and arylesterase activities were determined spectrophotometrically. Malondialdehyde (MDA) levels of apolipoprotein B-containing lipoproteins were determined before (basal) and after incubation with copper-sulphate, that yielded basal- and Delta-MDA values, respectively. Serum paraoxonase/arylesterase activities were significantly reduced in the post-treatment group compared with the pre-treatment group. Basal-MDA (MDA) level was significantly higher in the MDD group compared with the control group. Delta-MDA level of the severe MDD group was significantly higher than that of the control group. There was a positive correlation between the oxidizability of apolipoprotein B-containing lipoproteins and the severity of the disease. Total cholesterol, HDL-cholesterol, LDL-cholesterol, apolipoprotein B levels were significantly higher and apolipoprotein AI levels were significantly lower in the MDD group compared with those of the control group. The findings of the present study suggest that: 1) antidepressant treatment might reduce serum paraoxonase activity/mass; 2) oxidation and oxidizability of apolipoprotein B-containing lipoproteins seem to be increased in MDD.

Serum Lipids and Risk Factors for Attempted Suicide in Patients with Alcohol Dependence

BACKGROUND

Alcohol dependence is a major risk factor for suicidal behavior. Although a number of risk factors have been suggested there is still no well-defined risk profile for attempted suicide in alcoholic patients. Alterations of serum lipids have been associated with completed as well as attempted suicide and with suicidal ideation. This study investigated potential demographic and clinical risk factors for attempted suicide in alcohol-dependent patients taking serum lipids additionally into consideration.

METHODS

One-hundred ten alcohol-dependent patients who were admitted to a psychiatric university hospital department for inpatient treatment were grouped according to whether or not they had a lifetime history of attempted suicide. Attempters versus nonattempters as well as attempters who used a violent versus a nonviolent suicide method were compared.

RESULTS

Patients who had attempted suicide at least once in their life differed significantly from those who had no history of suicide attempts. Univariate analyses showed that they were younger (41.7 years vs 46.8 years; p = 0.003), were more often smokers (97% vs 77%; p = 0.011), had more frequently coabused benzodiazepines (54% vs 17%; p = 0.002), and scored currently higher on the Montgomery and Asberg Depression Rating Scale (MADRS) global scale (26.3 vs 20.2; p = 0.005) as well as the "suicidal thoughts" item (1.8 vs 0.6; p = 0.001). Additionally, they had higher serum triglyceride levels (178.9 vs 127.5; p = 0.039). A logistic regression analysis left coabuse of benzodiazepines [odds ratio (OR), 5.26; p = 0.001], younger age (OR per year increase of age, 0.91; p = 0.006), and current MADRS item 10 ("suicidal thoughts") score (OR per point increase in MADRS item 10 score, 1.43; p = 0.019) as significant factors. Suicide attempters who had used a violent method were significantly more often male (82% vs 44%; p = 0.035), were younger (38.2% vs 45.1 years; p = 0.008), and had less frequently coabused tranquilizers (35% vs 78%; p = 0.018) than nonviolent attempters.

CONCLUSIONS

These findings contribute to the development of a more specific profile of alcohol-dependent individuals at risk for suicidal behavior. Further research is required to determine the role of serum triglycerides for suicidal behavior in patients with alcohol dependence.

Leptin and cholesterol levels are low in major depressive disorder, but high in schizophrenia

BACKGROUND

Appetite, food intake and weight are frequently altered in psychiatric disorders such as major depression and schizophrenia. Leptin is an adipocyte hormone, as the product of the ob gene, regulating food intake and energy balance providing the hypothalamus with information on the amount of body fat. Leptin seems to be strongly associated with lipid metabolism. Moreover, leptin is involved in the control of other behaviors and in brain development. There are few studies about the amounts of plasma leptin in mood disorder and schizophrenia with inconsistent findings. The relationship between leptin and major depressive disorder is still unknown. We planned to investigate the relationship of the serum leptin concentration, cholesterol, and BMI between patients with major depressive disorder, schizophrenic patients and healthy control subjects.

METHODS

In the present study, the BMI, plasma cholesterol and leptin levels, BDI, and BPRS were compared in 69 patients with major depressive disorder, 78 schizophrenic patients, and 51 healthy controls.

RESULTS

The major findings of our study included (1) leptin and cholesterol levels were low in patients with major depressive disorder, but high in schizophrenic patients; (2) negative correlations between BDI scores and serum cholesterol or leptin levels in the patients with major depressive disorder; (3) an inconsistently positive correlation between mean leptin levels, cholesterol, and BMI among different groups; (4) positive correlations between serum cholesterol or leptin levels and the length of illness in the schizophrenic patients.

CONCLUSIONS

In this study, our results indicate that that leptin and cholesterol might play differently important pathophysiological roles in these psychiatric disorders.

Relationship between major depression and high serum cholesterol in Japanese men

Although it has been argued that those with lower levels of serum cholesterol are likely to be depressive, the findings are inconsistent. The present study attempted to clarify the relationship between major depression and serum total cholesterol in a working population. Subjects were 987 Japanese men working at an institute, aged 20 to 64 years. In addition to blood examinations and physical measurements, clinical structured interviews of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) were used to detect major depression. The prevalence of major depression was higher in the hypercholesterolemics (serum total cholesterol levels > or = 5.69 mmol/liter) than in the normocholesterolemics (3.10-5.69 mmol/liter) (6.1% vs 1.8%, p < 0.05). Notably, there was no case with major depression among the hypocholesterolemics (< 3.10 mmol/liter). Through a multiple regression analysis, serum total cholesterol levels were positively predicted by the following four variables: major depression, age, body mass index, and skipping breakfast (all p < 0.01). Concerning those diagnosed with major depression, serum total cholesterol levels remained higher in the following year (p < 0.05), comparing to those without such diagnosis. Therefore, depression is associated with higher serum cholesterol levels in a population of Japanese male workers. The irregularity of eating behavior may be one of the factors mediating high serum cholesterol levels and major depression.

Serum lipid profiles in major depression with clinical subtypes, suicide attempts and episodes

BACKGROUND

We tried to report the data between serum lipid profiles and major depression with different clinical subtypes, with or without suicide attempts, and with single episode or recurrent episodes.

METHOD

During a 2-year period, a total of 168 participants (109 patients with major depression and 59 subjects in a healthy control group) were recruited in this study. Blood samples for serum lipid profiles in all participants were collected. Data analysis was performed by using an analysis of covariance (ANCOVA) with body mass index (BMI) adjustment.

RESULTS

The data showed that there were no significant differences of any kind in serum lipid profiles between depressive patients with melancholic feature or atypical feature, with or without suicide attempts nor between depressive patients with single episode or recurrent episodes.

CONCLUSION

The results suggested there were no serum lipid profiles used as biological markers to distinguish the clinical subtypes, suicide attempts and episodes in patients with major depression.

Enhanced serum cholesterol and triglyceride levels in bulimia nervosa: relationships to psychiatric comorbidity, psychopathology and hormonal variables

Increased levels of cholesterol have been reported in patients with bulimia nervosa (BN), but all but one of the published studies were performed on non-fasting subjects, which limits the interpretation of this finding. Moreover, the relationships between serum lipids and comorbid psychiatric disorders or bulimic psychopathology have scarcely been investigated. We measured serum levels of total cholesterol, triglycerides, glucose, 17beta-estradiol and thyroid hormones in 75 bulimic women and 64 age-matched healthy females after an overnight fast. Compared with healthy women, bulimic patients exhibited significantly enhanced serum levels of cholesterol and triglycerides, but similar values of glucose, 17beta-estradiol, FT3 and FT4. No significant differences emerged in these variables between patients with or without comorbid depression, borderline personality disorder or lifetime anorexia nervosa. Circulating cholesterol was positively correlated to the patients' drive for thinness, ineffectiveness, enteroceptive awareness and impulse regulation sub-item scores of the Eating Disorder Inventory-2. These findings confirm that BN is associated with increased levels of serum lipids. This alteration may be involved in the pathophysiology of certain psychopathological characteristics of BN and cannot be explained by the co-occurrence of other psychiatric disorders.

Suicidal behaviors and drug abuse: impulsivity and its assessment

Impulsivity appears to play an important role in suicidal behaviors and drug abuse, which are two psychiatric problems that may interact with one another. Interpretation of the literature on impulsivity in these behaviors may be complicated by the variety of measurement techniques for the assessment of impulsivity. There are three general types of impulsivity assessment: self-report, biological, and laboratory behavioral. Because laboratory behavioral measures both meet an operational definition of impulsivity and are sensitive to state-dependent changes in impulsivity, this paper presents data that focuses on laboratory behavioral performance among samples emitting suicidal behaviors or substance abuse. To better account for influence of impulsivity in these psychiatric disturbances, no single source of measurement should be used without the consideration of other types of instruments.

Seasonal differences in psychopathology of male suicide completers

Suicide is known to vary according to season, with peaks in the spring and troughs in the winter. The presence of psychopathology is a significant predictor of suicidality, and it is possible that the seasonal variation of suicide completion may be related to seasonality in the manifestation of psychiatric disorders common to suicide completers. In the current study, we evaluated 115 French-Canadian male suicide completers from the Greater Montreal Area for DSM-IV psychiatric disorders using proxy-based diagnostic interviews. Subjects were assessed for seasonal differences in the prevalence of DSM-IV psychiatric diagnoses just before their deaths. Diagnoses of major depressive disorder (MDD) without comorbid cluster B personality disorders, and schizophrenia were differently distributed between seasons. Most (63.4%) subjects with MDD committed suicide in the spring/summer (P =.038). However, closer examination revealed that depressed suicides with comorbid cluster B personality disorders did not show seasonality, while 83.3% of depressed suicides without comorbid cluster B personality disorders committed suicide in the spring/summer (P =.019). 87.5% of those suicides with schizophrenia committed suicide in the fall/winter (P =.026), and the only suicide with schizophrenia who died in the spring/summer was also the only one without positive symptomology. Our study is limited to male suicide completers, and results should not be generalized to women. We conclude that seasonal variation in suicide manifests itself differently in patients with different psychopathology. These findings indicate that assessment of suicide risk may need to include consideration of possible seasonal effects, depending on psychopathology.

Lipid and lipoprotein levels in depressive disorders with melancholic feature or atypical feature and dysthymia

The purpose of the present study was to explore the relationship between serum lipid and lipoprotein levels and clinical subtypes in patients with depressive disorders. A total of 207 patients who were admitted for general health screening were assessed by using the semistructured clinical interview for Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria for the possibility of having depressive disorders. Blood and physical examinations were done to rule out systemic diseases. A total of 142 patients without systemic diseases was recruited for further analysis, including dysthymia (n = 35), major depressive disorder with melancholic feature (n = 22), major depressive disorder with atypical feature (n = 46) and normal controls (n = 39). Analysis of covariance after age adjustment reveals significant differences in patients with melancholic feature and patients with atypical feature in serum concentrations of triglyceride (TG) and very-low-density-lipoprotein cholesterol (VLDL) in men, and high-density-lipoprotein cholesterol (HDL) in women. This suggests that the TG, VLDL and HDL levels might be used as biological markers to differentiate between major depressive patients with melancholic feature or atypical feature.

No evidence for an association between serum cholesterol and the course of depression and suicidality

In a number of previous reports, an association of altered, in most cases lower, serum cholesterol levels with depression, suicidal ideation and current or past suicidal behavior has been suggested. In this investigation, the course of serum cholesterol concentrations was measured in depressed patients during treatment. Ninety-two inpatients with a major depressive episode were included. Serum lipid concentrations were assessed at admission, after 1 week and after 4 weeks of antidepressant treatment. Degrees of depression and suicidality were measured with the Hamilton Depression Rating Scale. Although there was a significant reduction in depression and suicidality scores, neither a significant change in serum cholesterol levels nor a correlation between cholesterol levels and clinical improvement was found. Further, there were no significant differences in lipid levels between patients with and without a history of attempted suicide. In patients who had used a violent method, there was a trend for lower total cholesterol levels compared to those who had poisoned themselves. The results of this study do not support the hypothesis of an association of serum cholesterol with the course of depression and suicidal ideation. Cholesterol levels do not appear to be an appropriate biological marker for suicidality during the first 4 weeks of treatment in patients with a major depressive episode.

Serum cholesterol and impulsivity in a large sample of healthy young men

Studies that have investigated the association between cholesterol levels and impulsivity are relatively few in number and have yielded equivocal results. In this study, we investigated the relationship between impulsivity, depression and serum lipids [total cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides] in a large sample (N=2051) of healthy young men who were remarkably homogeneous in terms of age, educational level, and socioeconomic conditions. Depression was assessed using the depression scale of the Minnesota Multiphasic Personality Inventory-2, and impulsivity was measured using the impulse control scale of the Big Five Questionnaire (BFQ). We found that subjects with a low serum cholesterol, defined as the lowest tenth of the total cholesterol distribution (< or =3.7 mmol/l), scored significantly lower on the impulse control scale of the BFQ. There was no significant association between depression and cholesterol concentrations. In addition, in a multiple regression model, both lower levels of total cholesterol and higher levels of HDL cholesterol emerged as significant predictors of impulsivity. However, since the regression model accounted for only 0.6% of the variance in the score on the impulse control scale of the BFQ, the biological significance of these correlations was negligible. Taken together, these findings suggest that, in healthy young men, a relationship between cholesterol and impulsivity emerges only when the statistical analysis focuses on subjects with very low levels of cholesterol.

Serum lipid levels and suicide attempts

OBJECTIVE

To determine whether a correlation exists between lower serum lipid concentrations and increased suicide risk.

METHOD

Serum lipid profiles were pair-matched for 60 patients who had recently experienced failed attempts at suicide and equal numbers of non-suicidal psychiatric patients, and normal controls. Suicide attempt severity was scored using Weisman and Worden's risk-rescue rating scale.

RESULTS

(a). Total serum cholesterol and low density lipoprotein levels were found to be lower in the parasuicidal population at statistically significant levels (P < 0.01 and <0.05, respectively); (b). triglyceride concentrations were lower in suicide attempters with major depression compared with non-suicidal depressed patients; and (c). risk-rescue rating scores were negatively correlated with total serum cholesterol levels (r = -0.347, P = 0.007).

CONCLUSION

Low lipid metabolism may be a potential biological marker in the assessment of suicide risk. Further investigations are necessary to elucidate the biological mechanisms of these findings.

Correlation between serum lipid, lipoprotein concentrations and anxious state, depressive state or major depressive disorder

The purpose of this study was to investigate the correlation between serum lipid, lipoprotein concentrations and anxious state, depressive state or major depressive disorder. A total of 207 patients admitted for general health screening were recruited during a 1-year period. Using the Chinese Health Questionnaire, the Taiwanese Depression Questionnaire and the semi-structured clinical interview for DSM-IV, one psychiatrist screened all participants for the presence of anxiety or depressive disorders. Blood samples for serum lipid and lipoprotein concentrations and physical examination records were collected simultaneously. For patients who did not have systemic diseases (n=162), we found that high-density lipoprotein (HDL) cholesterol and the ratio of total cholesterol (TC)/HDL differed significantly among anxious state, depressive state and normal groups in men after age adjustment. On the other hand, the ratios of TC/HDL and low-density lipoprotein (LDL)/HDL showed significant differences between patients with major depressive disorder and normal controls in women. This study suggested that the level of HDL cholesterol and the ratios of TC/HDL and LDL/HDL (atherogenic index) might be another markers of the possible association between serum lipids and anxiety or depression.

Serum leptin and cholesterol levels in patients with bipolar disorder

Low cholesterol levels have been reported in patients with manic episodes. Leptin seems to be strongly associated with lipid metabolism. In the present study, therefore, serum total cholesterol and leptin levels were compared in 16 patients with manic episodes, 16 with bipolar I disorder in full remission and 16 healthy controls. The serum total cholesterol and leptin levels were measured and Young Mania Rating (YMRS) and Hamilton Depression Rating Scales (HAM-D) were administered for each subject. Both the patients with manic episodes and the patients with bipolar I disorder in full remission had markedly low serum cholesterol and leptin levels compared with controls, though the difference was more obvious in patients with manic episodes. In addition, there were negative correlations between YMRS scores and serum cholesterol or leptin levels in the patients with manic episodes. Our results suggest that the patients with manic episodes and those with bipolar I disorder in full remission seem to be associated with decreased serum cholesterol and leptin levels.

Serum cholesterol levels and suicide: a meta-analysis

A meta-analysis was performed on studies exploring the link between low levels of serum cholesterol and increased risk of suicide. Follow-up studies found that those with lower cholesterol levels do have a tiny but statistically significant increased risk of completing suicide. Individuals who have attempted suicide in the past have lower cholesterol levels, especially if they used violent methods for suicide. Cholesterol lowering studies, however, did not lead to a significant increase in completed suicide.

Cholesterol concentrations in violent and non-violent women suicide attempters

The aim of this study was to evaluate whether women with a history of violent suicide attempts have lower serum cholesterol concentrations than those who attempted suicide by non-violent methods. Our retrospective study used a case-control design to compare serum total cholesterol concentration, hematocrit, red blood cell count and body mass index (BMI) in women with a history of violent (n = 19) or non-violent (n = 51) suicide attempts and of non-suicidal controls (n = 70) matched by diagnosis and age. Analysis of covariance (ANCOVA) with age as the covariate was used to analyze differences in cholesterol levels in groups according to violence. Violence was found to be a significant factor (P = 0.016). Using the Scheffé test, a significant difference (P = 0.011) was revealed between the group of violent and non-violent suicide attempters and between the violent suicide attempters and the control group. Patients with a violent suicidal attempt have significantly lower cholesterol levels than patients with non-violent attempts and the control subjects. Our findings suggest that suicide attempts should not be considered a homogeneous group. They are consistent with the theory that low levels of cholesterol are associated with increased tendency for impulsive behavior and aggression and contribute to a more violent pattern of suicidal behavior.

Serum creatine kinase levels in untreated hospitalized adolescents during acute psychosis

OBJECTIVE

Psychosis-associated creatine kinase (CK)-emia (PACK) is a common and pronounced laboratory abnormality that accompanies adult psychotic conditions. Adult PACK is a relatively consistent individual trait. The authors investigated whether psychotic adolescents also present with such PACK characteristics.

METHOD

Participants were 127 newly admitted, drug-free, psychotic Israeli adolescents. Measures were baseline psychotic severity, serum creatine kinase (CK0), lactate dehydrogenase (LDH0), glutamate oxaloacetate transaminase (SGOT0), white blood cell count (WBC0), urine myoglobulin, and the repeated CK (RepCK) measurements taken during recurrent psychotic episodes.

RESULTS

Schizophrenia was the prevalent diagnosis (53%). CK0 levels did not correlate with the severity of the psychotic symptoms. Twenty-one percent of patients had a CK0 level >1,000 IU/L. CK0 and RepCK levels were higher in males than in females (p < or = .001) and in Jewish Sephardi patients than in Ashkenazi patients (p < .007). There was no difference by diagnosis. Logarithmic (Ln) CK0 correlated with RepCK, SGOT0, LDH0, and WBC0 (r = +0.32-0.74, p < .001) but correlated inversely with serum cholesterol0 (r = -0.36, p = .002) in males. Even prominent PACK was not associated with myoglobinuria. These findings remained significant among the younger patients (aged <18 years). In males from this subgroup, LnCK0 also correlated with age (p < .007) but not with weight.

CONCLUSIONS

In psychotic adolescents, PACK is common, is more prevalent among males, is independent of diagnosis, is influenced by ethnicity, and tends to recur.

Serum cholesterol levels and mood symptoms in the postpartum period

During pregnancy, the total serum cholesterol concentration rises up to 43%, followed by a rapid fall after delivery. Mild depressive symptoms ('postpartum blues') are a common complication of the puerperium and affect 30-85% of women in the early postpartum period. Based on these observations, it has been suggested that the sudden fall in cholesterol levels after delivery could serve as a 'natural model' to test the suggested association between cholesterol and mood. The present study was designed to expand the database concerning the association between cholesterol levels and mood in the postpartum period and to address some methodological problems raised by previous studies. Forty-seven healthy primiparous women were interviewed with a structured clinical interview on two occasions: during late pregnancy (median: day -20 before the expected delivery) and during the early postpartum period (median: day 32 after delivery). On both occasions, serum concentrations of total and HDL cholesterol were measured and mood symptoms were assessed with the state form of Spielberger's State-Trait Anxiety Index (STAI), the state form of the State-Trait Anger Scale (STAS), and the Beck Depression Inventory (BDI). We found significant, albeit moderate, relationships between serum cholesterol levels and mood symptoms in the postpartum period that were not present during late pregnancy. Lower postpartum levels of total cholesterol were associated with symptoms of anxiety (r=-0.30, P=0.04), anger/hostility (r=-0.31, P=0.04), and depression (r=-0.35, P=0.02), and lower postpartum levels of HDL cholesterol were associated with symptoms of anxiety (r=-0.34, P=0.02). This study confirms that the physiological fall in blood lipids in the postpartum period can be a useful model to test the relationship between serum cholesterol levels and mood.

Biochemical markers of anxiety and depression

The results of research into a biochemical marker for depression are presented. The research was carried out on a normal population in a primary care setting. Cholesterol levels were identified as the blood marker for anxiety and depression. The Hamilton Rating Scale for Depression was chosen to identify depression. Those with low cholesterol scored significantly higher on the Hamilton Rating Scale for Depression.

Treating impulsivity and anxiety in the suicidal patient

It has been found that while over 90% of people who commit suicide have a psychiatric illness at the time, over 50% are under active psychiatric or mental health care. How can suicide risk be detected and preventive treatment provided? Both communication of suicidal ideation or intent and prior suicide attempts have been shown to be risk factors, which should be assessed in patients with psychiatric illness. Research shows that suicidal ideation is often not communicated to professionals or is denied by patients just prior to suicide and, when present, is often useful not as an immediate risk factor, but as a chronic risk factor. Suicide attempts predict a 10-30% occurrence of suicide over 10 years, but often do not indicate immediate risk. Recent research has shown that impulsiveness and severe anxiety, panic attacks, and agitation comorbid with depression are often immediate suicide risk factors that are potentially modifiable if recognized and treated urgently with effective medications and watchful support.

The neuropsychopharmacology of criminality and aggression

Although the idea that aggression has biological components is not a new one, recent research in genetics, neuropsychopharmacology, and neuroimaging has helped clarify the biological contributions to aggression. Studies to date have focused on serotonergic function and impulsive aggression. Reduced levels of cerebrospinal fluid (CSF) 5-hydroxyindoleacetic acid (5-HIAA) are associated with impulsive aggression. Pharmacochallenge studies have found decreased serotonergic responsiveness associated with impulsive aggression. Neuroimaging studies suggest a role for the prefrontal cortex, along with other regions of the brain, in the expression of aggression. Serotonin is not the only aspect of brain function implicated in impulsive aggression, and further work is being done on other neurotransmitters and neuropeptides.