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Sen P, Adewusi D, Blakemore AI, Kumari V. How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review. Aust N Z J Psychiatry 2022; 56:451-488. [PMID: 34240626 PMCID: PMC9036157 DOI: 10.1177/00048674211025608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females. METHOD Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal. RESULTS Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking. CONCLUSION There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.
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Affiliation(s)
- Piyal Sen
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Danielle Adewusi
- GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Alexandra I Blakemore
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Veena Kumari
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Veena Kumari, Department of Life Sciences, and Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK.
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de Bles NJ, Rius-Ottenheim N, Geleijnse JM, van de Rest O, Bogers JPAM, Schat A, Nijman HLI, van den Berg D, Joos L, van Strater A, de Ridder T, Stolker JJ, van den Hout WB, van Hemert AM, Giltay EJ. Effects of multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation on aggression among long-stay psychiatric in-patients: randomised clinical trial. BJPsych Open 2022; 8:e42. [PMID: 35109953 PMCID: PMC8867900 DOI: 10.1192/bjo.2022.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Aggression and violent incidents are a major concern in psychiatric in-patient care. Nutritional supplementation has been found to reduce aggressive incidents and rule violations in forensic populations and children with behavioural problems. AIMS To assess whether multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation would reduce the number of aggressive incidents among long-stay psychiatric in-patients. METHOD The trial was a pragmatic, multicentre, randomised, double-blind placebo-controlled study. Data were collected from 25 July 2016 to 29 October 2019, at eight local sites for mental healthcare in The Netherlands and Belgium. Participants were randomised (1:1) to receive 6-month treatment with either three supplements containing multivitamins, minerals and n-3 polyunsaturated fatty acid, or placebo. The primary outcome was the number of aggressive incidents, determined by the Staff Observation Aggression Scale - Revised (SOAS-R). Secondary outcomes were patient quality of life, affective symptoms and adverse events. RESULTS In total, 176 participants were randomised (supplements, n = 87; placebo, n = 89). Participants were on average 49.3 years old (s.d. 14.5) and 64.2% were male. Most patients had a psychotic disorder (60.8%). The primary outcome of SOAS-R incidents was similar in supplement (1.03 incidents per month, 95% CI 0.74-1.37) and placebo groups (0.90 incidents per month, 95% CI 0.65-1.19), with a rate ratio of 1.08 (95% CI 0.67-1.74, P = 0.75). Differential effects were not found in sensitivity analyses on the SOAS-R or on secondary outcomes. CONCLUSIONS Six months of nutritional supplementation did not reduce aggressive incidents among long-stay psychiatric in-patients.
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Affiliation(s)
- Nienke J de Bles
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
| | | | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University & Research, The Netherlands
| | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University & Research, The Netherlands
| | - Jan P A M Bogers
- Intensive Care Clinics, Mental Health Organization Rivierduinen, The Netherlands
| | - Anke Schat
- Department of Psychology, University of the Arts London, UK
| | - Henk L I Nijman
- Behavioural Science Institute, Radboud University, The Netherlands; and Forensic Psychiatric Institute, Fivoor, The Netherlands
| | - David van den Berg
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Netherlands; and Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, The Netherlands
| | - Lucas Joos
- Sector psychosezorg, PZ Bethaniënhuis, Belgium
| | | | | | | | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, The Netherlands
| | | | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Center, The Netherlands
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Hjell G, Mørch-Johnsen L, Holst R, Tesli N, Bell C, Lunding SH, Rødevand L, Werner MCF, Melle I, Andreassen OA, Lagerberg TV, Steen NE, Haukvik UK. Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders. Brain Behav 2020; 10:e01751. [PMID: 32681586 PMCID: PMC7507477 DOI: 10.1002/brb3.1751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 01/14/2023] Open
Abstract
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.
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Affiliation(s)
- Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway
| | - Lynn Mørch-Johnsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway
| | - René Holst
- Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway.,Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christina Bell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Andreas Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unn Kristin Haukvik
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Chen X, Xu J, Tang J, Dai X, Huang H, Cao R, Hu J. Dysregulation of amino acids and lipids metabolism in schizophrenia with violence. BMC Psychiatry 2020; 20:97. [PMID: 32131778 PMCID: PMC7055102 DOI: 10.1186/s12888-020-02499-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many studies have related biochemical characteristics to violence and have reported schizophrenia could elevated the risk of violent behaviour. However, the metabolic characteristics of schizophrenia patients with violence (V.SC) are unclear. METHODS To explore the metabolic characteristics of schizophrenia with violence and to identify potential biomarkers, untargeted metabolomics was performed by using gas chromatography time-of-flight mass spectrometry to analyse the plasma metabolites of fifty-three V.SC and twenty-four schizophrenia patients without violence (NV.SC). Multivariate and univariate analyses were performed to identify differential metabolites and biomarkers. Violence was assessed by the MacArthur Violence Assessment Study method. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale. RESULTS Multivariate analysis was unable to distinguish V.SC from NV.SC. Glycerolipid metabolism and phenylalanine, tyrosine and tryptophan biosynthesis were the differential metabolic pathways between V.SC and NV.SC. We confirmed ten metabolites and five metabolites as metabolic biomarkers of V.SC by random forest and support vector machine analysis, respectively. The biomarker panel, including the ratio of L-asparagine to L-aspartic acid, vanillylmandelic acid and glutaric acid, yielded an area under the receiver operating characteristic curve of 0.808. CONCLUSIONS This study gives a holistic view of the metabolic phenotype of schizophrenia with violence which is characterized by the dysregulation of lipids and amino acids. These results might provide information for the aetiological understanding and management of violence in schizophrenia; however, this is a preliminary metabolomics study about schizophrenia with violence, which needs to be repeated in future studies.
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Affiliation(s)
- Xiacan Chen
- Institute of Forensic Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Jiajun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tang
- Chengdu Compulsory Medical Center, Chengdu, China
| | - Xinhua Dai
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
| | - Haolan Huang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
| | - Ruochen Cao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
| | - Junmei Hu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
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Mensi R, Messaoud A, Mhallah A, Azizi I, Salah WH, Douki W, Najjar MF, Gaha L. The association between altered lipid profile and suicide attempt among Tunisian patients with schizophrenia. Ann Gen Psychiatry 2016; 15:36. [PMID: 28018476 PMCID: PMC5162100 DOI: 10.1186/s12991-016-0123-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been many studies on psychiatric disorders, but very little is known about the biology of suicide with schizophrenia. In the present study, we are looking for a possible connection between altered lipid profile and suicidal behavior in schizophrenic Tunisian patients. METHODS Assay of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) has been done for 126 schizophrenic patients with and without suicide attempts and 131 healthy controls recruited in the University Hospital of Monastir. RESULTS TC and LDL-c levels were significantly higher in schizophrenic patients compared to controls. TC was significantly lower in schizophrenic patients with suicide attempt compared to those without suicide attempt. Depending to the sonority of suicide attempt, TC was significantly lower in patients with recent suicide attempt compared to those with lifetime suicide attempt and without suicide attempt (p < 0.001), and no significant differences between TG, LDL-c, and HDL-c were noted. CONCLUSIONS Results of this study showed that TC levels in schizophrenic patients after a recent suicide attempt are significantly lower than in patients without suicide attempt and with lifetime suicide attempts. TC can be one of biological markers defined suicidal risk for schizophrenic patients.
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Affiliation(s)
- Rym Mensi
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Amal Messaoud
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Ahmed Mhallah
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Department of Psychiatry, University Hospital in Monastir, Monastir, Tunisia
| | - Islem Azizi
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Walid Haj Salah
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Department of Psychiatry, University Hospital in Monastir, Monastir, Tunisia
| | - Wahiba Douki
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Mohamed Fadhel Najjar
- Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Department of Psychiatry, University Hospital in Monastir, Monastir, Tunisia
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6
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Chen SC, Chu NH, Hwu HG, Chen WJ. Trajectory classes of violent behavior and their relationship to lipid levels in schizophrenia inpatients. J Psychiatr Res 2015; 66-67:105-11. [PMID: 26004299 DOI: 10.1016/j.jpsychires.2015.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/25/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the trajectory patterns of violence in schizophrenia inpatients, examine the relationships between the violence trajectories and baseline clinical features and lipid levels, and generate a model to predict the more violent trajectories. METHODS In a sample of 107 consecutively admitted patients with schizophrenia spectrum disorders, violent behavior was weekly rated using the Violence Scale. The patients' blood levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at admission. A trajectory analysis was used to classify the patients' longitudinal courses in violence, and the correlates of these trajectories were assessed using multinomial logistic regression analyses. A stepwise logistic regression was used to select the best predictor variables for the more violent trajectories. RESULTS Four violence trajectories of inpatients were obtained: class 1 (no violence, 37.4%), class 2 (low-leveling off, 39.2%), class 3 (high-falling sharply, 10.3%), and class 4 (high-falling slowly, 13.1%). Although the relationship between decreasing TC and TG levels and increased violence in the trajectory classes did not reach statistical significance, a decreasing trend in the proportion of high dichotomized-TG levels was significantly associated with more violence in the trajectory classes (p = 0.04). A five-variable model consisting of female gender, early onset, higher scores of positive symptoms, lower scores of negative symptoms, and low dichotomized-TC levels had a predictive accuracy of 0.85 (95% CI = 0.72-0.97). CONCLUSIONS Distinct violence trajectories exist in schizophrenia inpatients, and the more violent trajectories can be predicted using baseline clinical features and lipid levels.
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Affiliation(s)
- Shing-Chia Chen
- School of Nursing, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan
| | - Ni-Hsuan Chu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan
| | - Hai-Gwo Hwu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
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7
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Misiak B, Kiejna A, Frydecka D. Higher total cholesterol level is associated with suicidal ideation in first-episode schizophrenia females. Psychiatry Res 2015; 226:383-8. [PMID: 25618471 DOI: 10.1016/j.psychres.2014.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/06/2014] [Accepted: 12/19/2014] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
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Cantarelli MDG, Tramontina AC, Leite MC, Gonçalves CA. Potential neurochemical links between cholesterol and suicidal behavior. Psychiatry Res 2014; 220:745-51. [PMID: 25457283 DOI: 10.1016/j.psychres.2014.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 10/07/2014] [Accepted: 10/16/2014] [Indexed: 12/16/2022]
Abstract
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.
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Moses L, Katz N, Weizman A. Metabolic profiles in adults with autism spectrum disorder and intellectual disabilities. Eur Psychiatry 2013; 29:397-401. [PMID: 23849396 DOI: 10.1016/j.eurpsy.2013.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 05/19/2013] [Accepted: 05/22/2013] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- L Moses
- Health Services, Division for Intellectual and Developmental Disabilities, Ministry of Social Affairs and Social Services, Jerusalem, Israel; Maccabi Health Services, South District, Israel.
| | - N Katz
- Geha Mental Health Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Weizman
- Geha Mental Health Center, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Laboratory of Biological Psychiatry, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
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10
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Kobes MHBM, Nijman HHLI, Bulten EBH. Assessing aggressive behavior in forensic psychiatric patients: validity and clinical utility of combining two instruments. Arch Psychiatr Nurs 2012; 26:487-94. [PMID: 23164405 DOI: 10.1016/j.apnu.2012.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 04/24/2012] [Accepted: 04/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Accurate observation of aggressive behavior among forensic psychiatric patients requires valid instruments. This study examines the validity and clinical utility of combining the social dysfunction and aggression scale (SDAS) and staff observation aggression scale revised (SOAS-R). METHODS Nurses weekly obtained SDAS scores of 127 patients, resulting in 6.124 assessments. Aggressive incidents were documented by the SOAS-R. Internal consistency, subscale structure, interobserver reliability of the SDAS, and convergent validity with SOAS-R were analyzed. CONCLUSION A three-factor solution was found. Interobserver reliability was moderate, and good convergent validity was found. The SDAS, in conjunction with the SOAS-R, monitors changes in aggressiveness and may contribute to the prevention of aggressive behavior.
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Affiliation(s)
- Marjolein H B M Kobes
- Forensic Psychiatric Hospital Pompe Foundation, Division Diagnostics Research and Education, Nijmegen, The Netherlands.
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11
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Atmaca M, Kuloglu M, Tezcan E, Ustundag B. Serum leptin and cholesterol values in violent and non-violent suicide attempters. Psychiatry Res 2008; 158:87-91. [PMID: 18155776 DOI: 10.1016/j.psychres.2003.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2002] [Revised: 02/01/2003] [Accepted: 05/04/2003] [Indexed: 11/18/2022]
Abstract
Earlier studies have linked lipid metabolism to suicide and impulsive-aggressive behaviors. We previously reported that suicide attempters had significantly lower leptin and cholesterol levels than controls. Since lower cholesterol levels have been related to violence alone, we decided to evaluate serum total cholesterol and leptin levels in violent and non-violent suicide attempters. In the present study, 19 violent, 16 non-violent suicide attempters, and 20 age- and sex-matched healthy controls were compared for serum total cholesterol and leptin levels. Violent suicide attempters had significantly lower total cholesterol and leptin levels compared with those with non-violent suicide attempts. Our results suggest that low serum cholesterol and leptin levels are related to the following two dimensions of suicide attempts: suicidality and violence.
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Affiliation(s)
- Murad Atmaca
- Firat University, School of Medicine, Department of Psychiatry, Elazig, Turkey.
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Abstract
OBJECTIVE An overview of studies on predictors and on the accuracy of prediction of inpatient violence should be given. METHOD To date, the published data do not allow a systematic meta-analysis due to different sample characteristics, different measures and definitions of violence, and different time frames of observation. Published studies were reviewed regarding significant predictors of inpatient violence. RESULTS Predictors of violence in institutional settings are different from predictors of violence in the community: variables such as sex, age, diagnosis and alcohol abuse play a minor role, while clinical and psychopathological variables are prominent. Only history of violence is a robust static predictor. The total level of positive and general psychotic symptoms seems to enhance the violence risk of inpatients, whereas results concerning specific features like delusions or command hallucinations are contradictory due to inevitable problems of sample selection. The accuracy of clinical predictions is better than chance but limited by the effects of therapeutic interventions and research artefacts. CONCLUSION The author argues that more precise determinations of the violence risk in institutions will fail and that the role of environmental factors has often been underestimated.
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Affiliation(s)
- T Steinert
- Centre of Psychiatry Weissenau, Department of Psychiatry I, University of Ulm, Ravensburg-Weissenau, Germany
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Liu J, Wuerker A. Biosocial bases of aggressive and violent behavior—implications for nursing studies. Int J Nurs Stud 2005; 42:229-41. [PMID: 15680620 DOI: 10.1016/j.ijnurstu.2004.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 05/13/2004] [Accepted: 06/08/2004] [Indexed: 11/16/2022]
Abstract
Although aggression and violence have been increasingly viewed as a major public health problem with a biological and health basis, it has been under-researched in the nursing and health context. This paper reviews early biological risk factors for violence. These factors include pregnancy/birth complications, fetal exposure to nicotine, alcohol, and drugs, low cholesterol, malnutrition, lead and manganese exposure, head injuries and brain dysfunction, low arousal, low serotonin, low cortisol, and high testosterone. A biopsychosocial violence mode is proposed. Finally, the paper argues that nursing is ideally placed to develop a new body of knowledge based on a biosocial perspective that can lead to more effective prevention programs for violence.
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Affiliation(s)
- Jianghong Liu
- Social Science Research Institute, University of Southern California, Los Angeles, CA 90089-0375, USA.
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Nijman HLI, Palmstierna T, Almvik R, Stolker JJ. Fifteen years of research with the Staff Observation Aggression Scale: a review. Acta Psychiatr Scand 2005; 111:12-21. [PMID: 15636589 DOI: 10.1111/j.1600-0447.2004.00417.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Research on the prevalence and causes of in-patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful. METHOD Studies with SOAS aggression data were compiled using MEDLINE, the Internet, and references from SOAS papers. RESULTS Reviews of studies on psychometric properties suggest fair to good inter-rater reliability and validity for SOAS assessments. The number of aggressive incidents per patient per year found on acute admissions wards (n = 38) considerably varied, with a range of 0.4-33.2 incidents (mean = 9.3). CONCLUSION Although the aggression data included in the present review were obtained in highly comparable ways, substantial differences in aggression rates between wards were still found. Some countries (e.g. the Netherlands) appear to have a relatively high incidence of aggression on acute wards.
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15
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Karlović D, Buljan D, Martinac M, Marcinko D. Serum lipid concentrations in Croatian veterans with post-traumatic stress disorder,post-traumatic stress disorder comorbid with major depressive disorder,or major depressive disorder. J Korean Med Sci 2004; 19:431-6. [PMID: 15201512 PMCID: PMC2816847 DOI: 10.3346/jkms.2004.19.3.431] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2003] [Accepted: 03/08/2004] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to assess eventual differences in serum cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, LDL-C/HDL-C ratio between veterans with combat-related post-traumatic stress disorder (PTSD) only or comorbid with major depressive disorder (MDD), veterans with combat experiences with MDD, and healthy control group. PTSD and/ or MDD were diagnose according to structured clinical interview based on DSM-IV criteria. Additional criteria to diagnose PTSD were Clinician Administered PTSD Scale (CAPS), and to diagnose MDD Montgomery-Asberg Depression Rating Scale (MADRAS). Serum lipid concentrations were determined by using the enzyme-assay method. Veterans with combat-related PTSD as well as veterans with combat-related PTSD comorbid with MDD showed significantly higher concentrations of cholesterol (F=9.858, p<0.01), triglycerides (F=10.112, p<0.01), LDL-C (F=11.145, p<0.01), and LDL-C/HDL-C ratio (F=8.346, p<0.01) vs. veterans with MDD or healthy control group. Contrary healthy control group and veterans with MDD showed significantly higher concentrations of HDL-C (F=8.421, p<0.01), vs. veterans with PTSD or PTSD comorbid with MDD. In conclusion, there are no differences in serum lipid concentrations between veterans with combat-related PTSD and PTSD comorbid with MDD, but they have higher lipid concentrations than veterans with MDD or healthy control subjects.
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Affiliation(s)
- Dalibor Karlović
- University Department of Psychiatry, Sestre milosrdnice University Hospital, Vinogradska cestra 29, Zagreb, Croatia.
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Atmaca M, Kuloglu M, Tezcan E, Ustundag B. Serum leptin and cholesterol levels in schizophrenic patients with and without suicide attempts. Acta Psychiatr Scand 2003; 108:208-14. [PMID: 12890276 DOI: 10.1034/j.1600-0447.2003.00145.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies demonstrate a relationship between lipid metabolism and suicide or impulsive-aggressive behaviours. Leptin seems to be related with lipid metabolism. Therefore, the aim was to measure total serum cholesterol and leptin levels in 16 medication-free schizophrenic patients with and without suicide attempts and in 16 healthy controls. METHOD Subjects were assessed by using Impulsivity Rating (IRS) and Modified Overt Aggression Scale (MOAS). RESULTS The patients had lower total cholesterol and leptin levels in serum compared with the controls. Significantly lower total cholesterol and leptin levels were observed in patients who had attempted suicide compared with those who had not. The levels were observed to be low in violent attempters when compared with non-violent attempters. MOAS and IRS scores were negatively correlated with both cholesterol or leptin levels in patients. CONCLUSION The results indicated that medication-free schizophrenic patients have statistically significant lower serum cholesterol and leptin levels compared with controls and the difference is obvious in suicide attempters compared with non-suicide attempters and in violent attempters than non-violent attempters.
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Affiliation(s)
- M Atmaca
- Departments of Psychiatry and Clinical Biochemistry, Firat University, School of Medicine, Elazig, Turkey.
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17
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Vevera J, Zukov I, Morcinek T, Papezová H. Cholesterol concentrations in violent and non-violent women suicide attempters. Eur Psychiatry 2003; 18:23-7. [PMID: 12648892 DOI: 10.1016/s0924-9338(02)00011-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- J Vevera
- Psychiatric Clinic, 1st Medical Faculty, Charles University of Prague, Prague, Czech Republic.
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18
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Fessler DMT. Pseudoparadoxical impulsivity in restrictive anorexia nervosa: a consequence of the logic of scarcity. Int J Eat Disord 2002; 31:376-88. [PMID: 11948643 DOI: 10.1002/eat.10035] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explain an apparently paradoxical pattern wherein sufferers of restrictive anorexia nervosa exhibit both rigorous self-restraint and episodic impulsivity. METHOD The experimental, historical, and clinical literatures were examined for evidence of psychological and behavioral changes accompanying severe dietary constriction; such changes were noted and compared with those reported to occur in anorexics. RESULTS Increased impulsivity in association with dietary constriction is described in diverse literatures. A number of lines of evidence suggest that the serotonergic system mediates this change. DISCUSSION Many forms of impulsivity can be understood as having once constituted fitness-enhancing responses to resource scarcity. It is suggested that an evolved psychological mechanism calibrates the individual's sensitivity to risk in light of future prospects. Self-injurious behaviors are explicable as misfirings of such a mechanism. Similarly, excessive exercising by anorexics may reflect the misdirection of reward systems that normally encourage adaptive increases in ranging behavior under conditions of scarcity.
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Affiliation(s)
- Daniel M T Fessler
- Department of Anthropology, UCLA, Los Angeles, California 90095-1553, USA
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Manfredini R, Caracciolo S, Salmi R, Boari B, Tomelli A, Gallerani M. The association of low serum cholesterol with depression and suicidal behaviours: new hypotheses for the missing link. J Int Med Res 2000; 28:247-57. [PMID: 11191718 DOI: 10.1177/147323000002800601] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Several observational studies indicate that reduction of serum cholesterol levels is related to an increase in violent deaths and suicide but the nature of this possible relationship remains unclear. Many confounding factors, e.g. poor health, depression and loss of appetite may play a role in the apparent relationship between serum cholesterol levels and suicide. Two separate phenomena should be considered: lowering total cholesterol and low total cholesterol. This review considers the evidence from epidemiological studies on serum cholesterol lowering and psychiatric disturbances. The available evidence does not seem to substantiate the view that large-scale intervention to reduce cholesterol concentrations could lead to more violent and aggressive behaviour, and generally greater unhappiness. In recent trials using statin treatment, there were slightly fewer deaths from accidents and suicide in the treated group compared with the placebo group. We believe that clinicians should not be deterred from prescribing cholesterol-lowering drugs, to reduce the risk of death from coronary heart disease, when they are indicated.
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Affiliation(s)
- R Manfredini
- Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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Alvarez JC, Cremniter D, Gluck N, Quintin P, Leboyer M, Berlin I, Therond P, Spreux-Varoquaux O. Low serum cholesterol in violent but not in non-violent suicide attempters. Psychiatry Res 2000; 95:103-8. [PMID: 10963796 DOI: 10.1016/s0165-1781(00)00171-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many previous studies have suggested that low or lowered serum cholesterol levels may increase the risk of mortality not due to somatic disease: principally, suicide and violent death. Because violent death is rare, some studies have investigated afterwards the relation between cholesterol levels and either suicide attempts in psychiatric populations or violence in criminally violent populations. However, none of these studies have compared cholesterol levels in violent and non-violent suicide attempters. The blood of 25 consecutive drug-free patients following a violent suicide attempt and of 27 patients following a non-violent suicide attempt by drug overdose was drawn in the 24 h following admission. Patients with a diagnosis of alcohol abuse and with cholesterol-lowering therapy were excluded. Age, sex, body mass index, psychiatric diagnosis and the physical conditions of the suicide attempt were investigated. Thirty-two healthy subjects were used as a control group. There were no differences between the groups in age, frequency of psychiatric diagnoses or body mass index. There was more women in the group of non-violent suicide attempters than in that of violent suicide attempters (P<0.001). In analyses controlling for sex and age, the serum cholesterol concentration was 30% lower (F(2,82)=15.8; P<0.0001) in the group of violent suicide attempters (147+/-54 mg/dl) than in the group of non-violent suicide attempters (209+/-38 mg/dl) or control subjects (213+/-46 mg/dl). Our results showed that low serum cholesterol level is associated with the violence of the suicide attempt and not with the suicide attempt itself. Further investigations are necessary to determine the usefulness of this easily accessible parameter as a potential risk indicator for violent acts such as violent suicidal behavior in susceptible individuals.
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Affiliation(s)
- J C Alvarez
- Faculté de Médecine Paris-Ouest et Laboratoire de Biochimie, Hôpital R. Poincaré, AP-HP, 104 Bvd R. Poincaré, 92380 Garches, France.
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