Suicidal behaviour and addiction: an inseparable couple? Mechanisms underlying the association and targets for interventions

Suicidal behaviour is common in people with substance use disorder or behavioural addictions, and vice versa. Suicidal behaviour and addiction share many risk factors, such as increased allostatic load, and are associated with dysregulations of reward processing and impaired prefrontal cortex functioning, resulting in decision-making problems, loss of cognitive control, and impulsivity. Trait impulsivity predisposes the individual to increased sensitization to stressors or addictive stimuli. Addiction emerges when the motive for a pleasurable substance or activity transitions from positive to negative reinforcement. At this point, the stress response system is activated, and the main motivator shifts from pleasure to the escape from an aversive stimulus –withdrawal and craving. In parallel, insufferable psychological pain is the core component of the suicidal process, and a suicide attempt has been conceptualized as a way to reduce or escape it. Both states are associated with increased pain perception, stress system activation, inflammation, and anhedonia. However, while addiction generally reflects a shift from pleasure to the avoidance of negative stimuli, the pleasure is less identifiable in the suicidal process. Furthermore, not all individuals that engage in suicidal behaviours are impulsive or have an addiction, and not all individuals with addiction engage in suicidal behaviours. Yet, the understanding of the shared neurobiological component of addiction and suicidal behaviours may inform possible interventions in some individuals. Reward, pain, and stress systems are possible targets. Promising substances related to these systems that could reduce suicide risk include buprenorphine, lithium, ketamine, and psychological interventions aimed at psychological pain reduction and resilience. DISCLOSURE: No significant relationships

Risk factors for suicidal behaviours in late-onset bipolar disorder

Late-onset bipolar disorder (BD), when symptoms emerge after the age of 50 years, has gained recognition in the past decades. Currently, BD of about one in ten older patients is considered to be late-onset. Since suicide risk is extremely elevated in BD, especially at the onset of the illness, patients that live to old age are generally considered a survivor population. Meanwhile, patients with late-onset BD did not have BD while living through life periods that could be associated with typical risk factors for suicidal behaviours. Moreover, the late-onset BD might have specific etiopathogenesis, as demonstrated by less genetic component and more life stressors, medical comorbidity and alcohol use. Clinically, patients with late-onset BD have more depressive episodes and more favourable treatment outcomes, yet clinicians generally fail to adhere to guidelines while treating these patients. In n=614 older age BD patients from FondationFondamental Expert Centers, late-onset BD patients reported less lifetime suicidal ideation and attempts compared to non-late-onset patients, while there was no difference regarding the last year suicidal ideation. Better verbal memory was associated with more suicidal behaviour reporting in both groups. Meanwhile, late-onset patients had lower affect intensity and less childhood trauma – factors that were strongly positively associated with last year suicidal ideation in patients with earlier, but not late-onset BD. Meanwhile, late-onset BD patients had higher arterial blood pressure, which was associated with lifetime suicide attempt history in them, but not in earlier-onset patients. Late-onset BD seems to have a distinct pathway to suicidal behaviours. DISCLOSURE: No significant relationships

Use of cognitive enhancers among medical students in Lithuania

Aims - The purpose of this study is to analyse the use of cognitive enhancers among medical students in Lithuania, determine the reasons for usage and evaluate the contributing factors such as socio-demographic characteristics, stress levels, sleep quality and knowing somebody who has used a neuro-enhancing drug. Design A cross-sectional survey study was performed by analysing a convenience sample of n=579 in the two universities offering medical education in Lithuania, Vilnius University and the Lithuanian University of Health Sciences. In 2014, students were asked to fill in anonymous paper questionnaires consisting of 13 items on prevalence of substance use to enhance cognitive performance, and on reasons and correlates (response rate 95%) during lecture time. Results - Of the respondents, 8.1% indicated that they had used cognitive enhancers. Among those who had used these drugs, nootropics were the most frequently mentioned (59.6%), while psychostimulants, such as modafinil, methylphenidate and amphetamine-derived drugs were mentioned less frequently (38.3%). Other substances were indicated by 23.4% of the respondents. Improvement of concentration and increased studying time were predominant purposes (55.3% and 48.9% of users, respectively). Male students reported three times higher prevalence rates than females (14.6% vs. 5.1%, p<0.05). Prevalence was also higher in students who knew someone using these substances than among those who did not know such persons (17.3% vs. 5.1%, p<0.05). This was the most associated factor with cognitive-enhancing drug-taking behaviour. No correlation between cognitive enhancement usage and sleep quality or stress levels was found, nor between usage and belonging to a student organisation or having a job. Conclusions - In Lithuania, 1 of 12 medical students admits to having used neuro-enhancing drugs. Our study results provide an overview of the actual situation on correlates and reasons for taking performance-enhancing substances

Significant Association Between Huntingtin Gene Mutation and Prevalence of Hopelessness, Depression and Anxiety Symptoms

International audienceBackground: In Huntington’s disease psychiatric symptoms may manifest prior to motor dysfunction. Such symptoms negatively impact people’s quality of life and can worsen the course of the primary disease. The aim of the present study was to assess and compare depression, anxiety and hopelessness rates in individuals with and without an abnormal expansion of CAG repeats in the huntingtin (HTT) gene and healthy controls.Materials and methods: Study involved 31 individuals referred for genetic testing for Huntington’s disease and a control group of 41. Depressive and anxiety symptoms were assessed using Beck Hopelessness Scale (BHS) and Hospital Anxiety and Depression Scale (HADS). Results between groups were compared using the Mann–Whitney U test. Two-sided Bonferroni corrected p-value was set at ≤0.017.Results: Individuals with HTT gene mutation (“gene mutation positive”, GMP) (N=20) scored higher on the HADS depression subscale (5.90 ± 4.52 vs 1.36 ± 1.91; p ≤ 0.017) than those without HTT gene mutation (“gene mutation negative”, GMN) (N=11). GMP and control groups scored higher than the GMN group on the BHS (5.65 ± 3.91 vs 2.09 ± 1.64 and 5.27 ± 4.11 vs 2.09 ± 1.64, respectively; p ≤ 0.017). No differences in anxiety levels were found.Conclusions: Depressive symptoms and hopelessness were more prevalent in individuals with HTT gene mutation than in individuals who were tested but had no said mutation. Such results emphasise the importance of timely diagnosis and treatment of psychiatric comorbidities in individuals affected by Huntington’s disease

Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in depressed patients with suicidal behavior: a systematic review /

Background: Inflammatory biomarkers are reportedly increased in depressed patients. Several studies have been conducted using neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR). The objective of this systematic review was to study the relationship between these peripheral biomarkers and suicidality in depressed patients with/without suicidal behavior, including suicide attempts and ideation, and healthy controls. Methods: We searched the following relevant terms in the PubMed, Web of Science, and Scopus databases published in the last five years. We ssessed the methodological quality of included studies using the Oxford criteria and reviewed the evidence following PRISMA guidelines. Results: Eleven studies were retained for the data synthesis, with a total sample of 1,701 participants, of which the majority (819) were patients with depression and suicidal behavior, 494 were depressed patients without suicidal behavior, and only 388 were healthy participants. Our results reinforce the idea that NLR could be an attractive, convenient, and cost-ffective trait marker of suicidal vulnerability in patients with major depressive disorder (MDD). Conclusion: Future large-scale replication studies are needed to examine the apparently understudied role of PLR and MLR in depressed patients in greater depth

Association of markers of inflammation and intestinal permeability in suicidal patients with major mood disorders /

Background: Patients with major mood disorders are at high risk of suicidal behavior compared to the general population. Suicide is a public health concern, accounting for around 1.2% of deaths worldwide. Understanding its underlying mechanisms may help identify predictive biomarkers and design novel targeted treatments. Immune dysfunctions, in particular affecting the gut-brain axis, are of interest given their dual involvement in mood disorders and suicidal behavior. We thus explored the possible relationships between suicide attempt (SA) and circulating biomarkers of intestinal permeability and systemic inflammation in patients with major depressive disorder (MDD) or bipolar disorder (BD) with and without a history of SA. Method: 137 patients with BD and 168 with MDD were included, and among them, 133 had a history of SA and 172 did not. Among them, 104 were males (34%) and 201 females (66%). Depressive symptoms were evaluated using the Inventory of Depressive Symptomatology clinical scale (IDS-C30). Circulating levels of intestinal fatty acid binding protein (IFABP), calprotectin, apolipoprotein E (ApoE), lipopolysaccharides binding protein (LBP), lipopolysaccharides (LPS), soluble beta-2-microglobulin (B2m), and C-reactive protein (CRP), were determined. Multivariate linear regressions were performed according to the gender status given the proportion of the herein studied male and female individuals and the higher propensity of females to experience SA as compared to males. Results: After adjusting for confounding variables, patients in the SA group had significantly higher CRP, and lower IFABP levels in comparison to the NSA group. Limitations: The unavailability of confounding variables such as dietary habits, should be noted. In addition, the cross-sectional nature of the study hampers the identification of causative effects. Conclusion: Although preliminary, our observations revealed associations between markers of inflammation and intestinal permeability in patients with suicidal behavior warranting further confirmation in larger cohorts