The psychobiology of aggressive behaviour.

Among psychiatric illnesses, genetically determined disorders usually have an early onset and a severe and complicated course. Gene-environmental interaction is of importance for aggressive impulsive behaviour. For example, alcoholism type II has a high family loading, a severe course, and is often associated with antisocial behaviour. In order to gain further understanding of aggressive and impulsive behaviour, genes determining serotonin metabolism, neurosteroids and carbohydrate metabolism should be of interest to investigate. Furthermore, modern brain-imaging studies will reveal the site of action of aggressiveness and impulsivity. Within brain regions of interest, biological studies will promote our knowledge of this deleterious behaviour

Salivary cortisol and suicidal behavior-A follow-up study.

INTRODUCTION: Hyperactivity of the hypothalamic-pituitary-adrenal (HPA)-axis is a common finding in major depressive disorder. Similar studies on suicide attempters are less abundant, and the results are divergent. The main aim of the present study was to investigate HPA-axis parameters by the time of a suicide attempt and at follow-up in search for associations between HPA-axis function and suicidal behavior. METHODS: Thirty-five suicide attempters and 16 non-suicidal controls were admitted to a psychiatric ward between the years of 1986 and 1992. Corticotrophin-releasing hormone (CRH) in cerebrospinal fluid and urinary cortisol were obtained for the suicide attempters. The patients were followed up approximately 12 years after the index admission. Cortisol was measured in saliva, and additional suicide attempts and current psychiatric symptoms were registered. RESULTS: At follow-up, evening salivary cortisol was lower in suicide attempters compared to controls. Low cortisol levels at follow-up were associated with severe psychiatric symptoms. Among women, repeated suicide attempts were associated with low morning and lunch salivary cortisol, and in this subgroup we also found significant correlations between salivary cortisol at follow-up, and CRH as well as urinary cortisol at index. CONCLUSION: We found evidence for an association between low HPA-axis activity and suicidal behavior. This could be due to long-lasting and severe psychiatric morbidity, which in turn has exhausted the HPA-axis of these patients. The potential role of hypocortisolism should be given more attention in studies on suicidal patients

The role of dopamine and serotonin in suicidal behaviour and aggression

Serotonin and dopamine are two monoamines which are known to interact with each other. Their role for suicidal behaviour, aggression and mood are reviewed in this chapter. We found a substantial amount of evidence for the relevance of a serotonin and dopamine model of aggression, and for aggression as a major risk factor for suicide. Evidence was found that serotonin and dopamine also may be involved in depressed mood, and possibly the individual's ability to cope with imminent suicidality

High Suicidal Intent Scores Indicate Future Suicide

he aim of this study was to scrutinize individual items as well as total scores of the Suicidal Intent Scale (SIS) in order to find out its usefulness for predicting suicide. Consecutive patients (N=555) were evaluated and rated with SIS shortly after a suicide attempt. When followed up at a mean time of 4.5 years, 22 (4%) had committed suicide. Those who later committed suicide had been scored significantly higher than those who did not commit suicide. In an effort to find a score-limit of the SIS which could be associated with future suicide, we formulated a receiver operating characteristic curve. From this we were able to detect a sensitivity of 90% and a specificity of 60.3% of scores of 19 and above in people aged 55 years and older. In a logistic regression analysis we also found that age above 55 years, mood disorder diagnoses and SIS scores of 19 or above significantly predicted suicide. Our conclusion is that the SIS could be a valuable tool in predicting suicide, especially in elderly suicide attempters

Disentangling dysthymia from major depressive disorder in suicide attempters' suicidality, comorbidity and symptomatology.

Dysthymia and major depressive disorder (MDD) are both risk diagnoses for suicidal behaviour. The aim of the present study was to identify clinical differences between these disorders, with a special reference to dysthymia. We studied suicidal behaviour, comorbidity and psychiatric symptoms of inpatient suicide attempters with dysthymia and MDD. We used DSM III-R diagnostics, the Suicide Assessment Scale (SUAS) and the Comprehensive Psychopathological Rating Scale (CPRS), part of which is the Montgomery and Asberg Depression Rating Scale (MADRS). Suicide mortality, number of repeated suicide attempts, method of suicide attempt and comorbidity of Axis I did not differ between the groups. Dysthymia patients, however, suffered more than MDD patients from DSM-III-R Axis II diagnoses (above all cluster B). There was no significant difference in Axis III comorbidity. Total SUAS, CPRS and MADRS scores did not differ significantly between the groups. When studying separate SUAS and CPRS items in a multivariate analysis, the CPRS items "aches and pains", "increased speech flow", increased "agitation" and "less tendency to worrying over trifles" as well as young age remained independently associated with dysthymia. Dysthymia patients, who later committed suicide, more often reported increased "aches and pains" than those who did not commit suicide. In this small sample of suicide attempters, we conclude that dysthymia suicide attempters, more often than MDD patients, have a comorbidity with personality disorders, which combined with a picture of aches and pains, could be factors explaining their suicidality

The long-term stability of temperament traits measured after a suicide attempt. A 5-year follow-up of ratings of Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate whether or not temperament dimensions are stable over time. Twenty-six patients (21 women and five men) filled in the Karolinska Scales of Personality (KSP) both at admission after a suicide attempt (index) and at follow-up 5 years later. KSP changes were significantly associated with low severity of psychiatric symptoms and no reported reattempts at follow up. There were significant changes of all five groups of KSP, most prominently in anxiety-related scales. At index, KSP scores did not differ between those who later would repeat a suicide attempt (repeaters) and not, but repeaters more often tended to have a personality disorder and their 24-h urinary cortisol tended to be lower. In this limited sample, repeaters seem to have a protracted high anxiety level as mirrored by high and stable KSP scores over time

Suicidal Intent and the HPA-Axis Characteristics of Suicide Attempters with Major Depressive Disorder and Adjustment Disorders.

The main purpose of the study was to investigate Hypothalamic-Pituitary-Adrenal (HPA) axis characteristics in relation to suicidal intent among suicide attempters with Major Depressive Disorder (MDD) and Adjustment Disorders (AD). The relationship between suicidal intent, assessed by means of the Suicidal Intent Scale (SIS), and serum cortisol after a Dexamethasone Suppression Test (DST) was investigated in 78 suicide attempters, divided into diagnostic subgroups. There was a significant negative correlation between suicidal intent and post DST cortisol in patients with MDD. Our findings may be attributed to pathophysiological processes, where a high suicidal intent is revealed during a potential chronic course of MDD, which in turnresults in a seemingly normal stress system