A comparative study of inflammatory marker highly sensitive C- Reactive Protein in depression patients exhibiting suicidal behaviour and depression patients without suicidal behaviour

Background: Recent research have found a link between inflammatory pathway and suicidal behaviour. hs-CRP, IL, TNF have been shown to have significant alterations in suicidality, however multiple covariates influence this relationship. One of the main limitations of most of the studies is that they have evaluated the CRP in patients demonstrating suicidal behaviour but not in depression. No study has been conducted in Indian subpopulation with parameters of our study. Aims of the study was to compare hsCRP levels between depression patients with suicidal behaviour and without suicidal behaviour.Methods: Authors compared 50 depression patients with suicidal behaviour and 50 depression patients without suicidal behaviour, diagnosed using ICD10. Hamilton Depression Rating Scale (HDRS‑17), Suicide behaviour Questionnaire- Revised (SBQ-R), Beck Scale for Suicidal Ideation (BSSI) were applied for assessment of depression and suicidality. Highly sensitive CRP was measured using autoanalyzer.Results: hsCRP levels were significantly high in depression patients with suicidal behaviour (4.12 mg/dl) than depression without suicidal behaviour (2.42 mg/dl). Duration of illness, HAM-D, BSSI and SBQ-R scores correlated positively with hsCRP levels.Conclusions: Depression with suicidal behaviour patients have a significantly higher hs-CRP levels than depression without suicidal behaviour. Patients of depression with suicidal behaviour group have a strong positive correlation between hs-CRP levels and HAM-D, BSSI and SBQ-R scores

A comparative study of picolinic acid levels in patients of severe depression with and without suicidality

Background and Aim: Picolinic acid (PIC) is a metabolite of the kynurenine pathway, which is involved in the degradation of tryptophan, an essential amino acid. PIC has been suggested to have neuroprotective effects by inhibiting the production of quinolinic acid, a neurotoxic agent that can induce inflammation and oxidative stress in the brain. Several studies have reported the altered levels of PIC and other kynurenine metabolites in patients with suicidal behavior, indicating a possible link between PIC and suicide risk. However, the exact role of PIC in the pathophysiology of suicide is not fully understood and requires further investigation. We aim to assess the levels of PIC in patients with severe depression with and without suicidal attempts. Materials and Methods: A cross-sectional, observation study was conducted at MGM Medical College, Indore. The study consisted of two groups: Group A including patients of depression with suicidal attempt(s) and Group B including patients of depression without any suicidal attempt. After obtaining written informed consent, recruitment of the subjects was done as per strict inclusion criteria and exclusion criteria. Sociodemographic parameters such as age, gender, residence, and marital status were collected along with the clinical parameters such as Hamilton depression rating scale (HAM-D), Suicidal Behavior Questionnaire Revised (SBQ-R) score, and Beck Scale for suicidal ideation (BSSI). Blood samples of both the groups were measured for serum PIC using an auto analyzer. Results: Serum PIC levels were significantly lower (124.33 ± 51.15 ng/L) in the depression with suicidal attempt group than depression without suicide attempt which was 163 ± 41.28 ng/L (P < 0.01). SBQ-R, BSSI score, and number of suicide attempts correlated negatively with serum PIC levels. Conclusion: The depression with suicidal attempt(s) group has shown lower mean serum PIC levels than the depression without suicidal attempt(s) group, which was statistically significant. This indicates serum PIC could be a marker in severe depression

Exacerbation of pica as a precursor of psychosis

Pica is a sustained, compulsive eating behavior of nonedible substances. Pica has been described as sequelae of psychosis due to its state of disorganization; however, temporal and causal relationship between the two has not been reported in the context of exacerbation of pica before psychosis. Various causes of pica have been identified including malnutrition, iron-deficiency anemia, zinc deficiency, intellectual disability, and obsessive and impulse control disorders. Here, we describe a case of worsening pica which preceded exacerbation of psychosis in an 18-year-old female which was managed with antipsychotics along with complete remission of psychosis and improvement in the severity of pica. The present case highlights the association between psychosis and pica. There has been a rising voice in academia to reclassify pica alongside obsessive–compulsive disorder (OCD) with no absolute consensus. In conclusion, our findings suggest that the exacerbation of pica preceded psychosis and can be construed as an indicator for an upcoming psychotic episode or as a prodromal aspect of psychosis and may be useful for early identification and initiation of treatment in cases of relapsing psychosis