Physical compared to mental diseases as reasons for committing suicide: a retrospective study

Background: Several studies investigated the relationship between mental disorders and suicidal ideation. However, little is known about physical illnesses being the major trigger for committed suicides. It is necessary to understand these risk factors to be able to meet the needs of patients in a palliative care setting. Methods: Suicide, medical and police notes were retrospectively analysed from all autopsies conducted in 2009-11 at the University of Munich, Germany. Documented reasons for suicide were classified into a "physical disease" (PD) or "mental disease" (MD) group and compared with respect to their sociodemographic characteristics and autopsy outcomes. Results: Of all 1069 cases, 18.9 % gave a PD as reason for committing suicide (MD, 32.7 %). Those indicating PD were older than MD (68.8 vs. 48.7 years;p < 0.001) with more men being in this group (72.8 % vs. 59.1 %;p=0.002). In PD, 30.7 % suffered from cancer, 28.7 % from chronic pain and 12.4 % from lung disease. 38.8 % of MD and 12.4 % of PD had previous suicide attempts. Conclusions: In palliative care, it is necessary to screen patients on a regular basis for suicidal ideation, especially those with previous suicide attempts

Physical compared to mental diseases as reasons for committing suicide: a retrospective study

Background: Several studies investigated the relationship between mental disorders and suicidal ideation. However, little is known about physical illnesses being the major trigger for committed suicides. It is necessary to understand these risk factors to be able to meet the needs of patients in a palliative care setting. Methods: Suicide, medical and police notes were retrospectively analysed from all autopsies conducted in 2009-11 at the University of Munich, Germany. Documented reasons for suicide were classified into a "physical disease" (PD) or "mental disease" (MD) group and compared with respect to their sociodemographic characteristics and autopsy outcomes. Results: Of all 1069 cases, 18.9 % gave a PD as reason for committing suicide (MD, 32.7 %). Those indicating PD were older than MD (68.8 vs. 48.7 years;p < 0.001) with more men being in this group (72.8 % vs. 59.1 %;p=0.002). In PD, 30.7 % suffered from cancer, 28.7 % from chronic pain and 12.4 % from lung disease. 38.8 % of MD and 12.4 % of PD had previous suicide attempts. Conclusions: In palliative care, it is necessary to screen patients on a regular basis for suicidal ideation, especially those with previous suicide attempts

Influence of Short-Term Glucocorticoid Therapy on Regulatory T Cells In Vivo

Background: Pre- and early clinical studies on patients with autoimmune diseases suggested that induction of regulatory T(Treg) cells may contribute to the immunosuppressive effects of glucocorticoids(GCs). Objective: We readdressed the influence of GC therapy on Treg cells in immunocompetent human subjects and naı¨ve mice. Methods: Mice were treated with increasing doses of intravenous dexamethasone followed by oral taper, and Treg cells in spleen and blood were analyzed by FACS. Sixteen patients with sudden hearing loss but without an inflammatory disease received high-dose intravenous prednisolone followed by stepwise dose reduction to low oral prednisolone. Peripheral blood Treg cells were analyzed prior and after a 14 day GC therapy based on different markers. Results: Repeated GC administration to mice for three days dose-dependently decreased the absolute numbers of Treg cells in blood (100 mg dexamethasone/kg body weight: 2.861.86104 cells/ml vs. 336116104 in control mice) and spleen (dexamethasone: 2.861.96105/spleen vs. 956226105/spleen in control mice), which slowly recovered after 14 days taper in spleen but not in blood. The relative frequency of FOXP3+ Treg cells amongst the CD4+ T cells also decreased in a dose dependent manner with the effect being more pronounced in blood than in spleen. The suppressive capacity of Treg cells was unaltered by GC treatment in vitro. In immunocompetent humans, GCs induced mild T cell lymphocytosis. However, it did not change the relative frequency of circulating Treg cells in a relevant manner, although there was some variation depending on the definition of the Treg cells (FOXP3+: 4.061.5% vs 3.461.5%*; AITR+: 0.660.4 vs 0.560.3%, CD127low: 4.061.3 vs 5.063.0%* and CTLA4+: 13.8611.5 vs 15.6612.5%; * p,0.05). Conclusion: Short-term GC therapy does not induce the hitherto supposed increase in circulating Treg cell frequency, neither in immunocompetent humans nor in mice. Thus, it is questionable that the clinical efficacy of GCs is achieved by modulating Treg cell numbers

Modulation of CD4⁺ T cells and T_reg cells by GCs in mice.

<p>Peripheral blood (A, C, E) and spleen (B, D, E) cells from C57BL/6 mice were analyzed by flow cytometry before, 3 days after IP treatment with different dosages of dexamethasone and 14 days after IP treatment with 100 mg/kg dexamethasone followed by oral taper. The absolute numbers of CD4⁺ T cells (A, B) and CD4⁺CD25^highFOXP3⁺ T_reg cells (C, D) were assessed and the relative frequency of T_reg cells amongst all CD4⁺ T cells was calculated (E, F); *p<0.05, **p<0.01.</p

Effect of GC on the function of T_reg cells <i>in vitro</i>.

<p>T_h cells (5×10⁴ cells / well) were incubated with T_reg cells at different ratios in the presence of irradiated APC (30 Gy, 10⁵ cells / well) and Con A (2,5 µg / ml) for 48 hrs, either with dexamethasone (dex, 5 nM) or without it (con). Resting T_h cells as well as T_h and T_reg cells stimulated with Con A served as controls. Proliferation was determined by ³H-TdR incorporation during an additional 16 hrs culture period (A), IL-2 levels were directly measured in the supernatants by ELISA (B). All values were normalized to stimulated T_h cells treated with or without Dex, respectively. In both panels the combined data of three independent experiments are depicted.</p

Flow cytometric analysis of T_reg cells according to different markers.

<p>Peripheral blood from one representative hearing-loss patient treated for 3 days (A, C, E, G) and 14 days (B, D, F, H) with glucocorticoid regimen was analyzed for the presence of regulatory T cells according to the following markers: CD4⁺ CD25^high and FOXP3⁺ (A, B), AITR⁺ (C, D) CD127_low (E, F) and CTLA4⁺ (G, H). Only CD4⁺ cells are depicted and the percentages indicate the relative frequency of T_reg cells within this subpopulation.</p

Modulation of CD4⁺ T cells and T_reg cells by GCs in humans.

<p>Peripheral blood cells from acute hearing loss patients before and 14 days after prednisolone treatment were analyzed by flow cytometry and the absolute numbers (A, C, E, G, I) and the frequency (B, D, F, H, J) of CD4⁺ T cells (A, B) and T_reg cells (CD4⁺CD25^high and FOXP3⁺ (C, D), AITR⁺ (E, F), CD127^low (G, H) or CTLA4⁺ (I, J)) were assessed; *p<0.05, ***p<0.001.</p

Lymphocyte counts and percentages in the blood and spleen of mice before and after GC therapy <i>in vivo</i>.

<p>* =  as subpopulation of CD4⁺CD25^high cells.</p><p>‡ =  % out of CD4⁺ cells ± SD.</p