The prospectively observed course of illness among depressed patients who commit suicide
ABSTRACT These analyses were conducted to describe the course of illness among patients with major affective disorders who commit suicide.
Twenty-nine patients who entered a long-term, high-intensity follow-up study of major affective disorders and who later committed suicide within 1 year of their last follow-up interview were individually matched to other patients by age, sex, the presence or absence of lifetime drug or alcohol abuse, time to last interview and polarity. Those who suicided were compared with their controls by depressive and substance abuse morbidity during follow-up, treatment resistance, treatment compliance, suicidal behavior and psychosocial adjustment.
Among the various measures used to characterize the course of illness during a mean follow-up of 4.3 years, only those pertaining to suicidal behavior robustly separated the suicide group from their controls. Suicidal behavior in the remote past seemed as predictively important as suicidal behavior during follow-up.
Of the various features monitored over time in patients with major affective disorder, suicidal behavior itself was the clearest correlate of risk for completed suicide.
- SourceAvailable from: J. John Mann
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- "Clearly the same kind of study would be unethical in those at risk for suicidal behavior. Clinical prospective studies have suggested that risk for suicidal acts might be associated with phases of depressive episodes or subtype of depressive disorder (Berglund & Nilsson, 1987; Brinkman-Sull, Overholser, & Silverman, 2000; Coryell, Haley, Endicott et al., 2002; Leon, Keller, Warshaw et al., 1999). The finding of a serotonergic abnormality in euthymic patients with a history of major depression, as shown by a depressive response to tryptophan depletion (Delgado, Price, Miller etal.,1994;Heninger,Delgado,Charneyetal., 1992; Moreno, Gelenberg, Heninger et al., 1999; Price et al., 1991; Smith, Morris, Friston et al., 1999) and a blunted prolactin response to serotonin release by fenfluramine during remission (Flory, Mann, "
ABSTRACT: Predicting suicide is difficult due to the low base rate, even in high-risk groups, and the multi-causal nature of suicidal behavior. Clinical predictors have shown low specificity. Retrospective and cross-sectional studies have identified a number of biologic anomalies associated with suicide and suicide attempt. Prospective studies provide estimates of the predictive utility of biologic measures. Here we review prospective studies of suicidal behavior and serotonergic, noradrenergic, dopaminergic and hypothalamic-pituitary-adrenocortical axis function in mood disorders. The most promising biologic predictors are low CSF 5-HIAA and HPA axis dysfunction as demonstrated by dexamethasone non-suppression that are each associated with about 4.5 fold greater risk of suicide.Archives of Suicide Research 02/2007; 11(1):3-16. DOI:10.1080/13811110600993124 · 1.64 Impact Factor