Altruistic suicides: are they the same or different from other suicides?

Suicidology is not alone in wrestling with the question, 'who are the altruistic suicides?' A review of a series of studies published in Archives of Suicide Research, suggests that maybe they are not different from other suicides. They are suicides; a case study of a "martyr" note reveals a suicide note. Emile Durkheim's sociological taxonomy suggests that the difference is probably on the outside, the social world. Yet, who decides what is honorable or not? Who are the suicide bombers? Martyrs? Terrorists? It appears that society(ies) defines the event, probably not the psychological aspects of the suicide(s). More research is, however, needed, but there are many obstacles to such study.     

Risk factors of future suicide in suicide attempters – A comparison between suicides and matched survivors

The objective of this study was to find risk factors for suicide by looking for clinical and care/treatment consumption differences between 15 hospitalized suicide attempters, who later committed suicide (“completers”), and 15 suicide attempters who did not (“non-completers”), matched according to sex, age and principal diagnosis. Completers had significantly more often attempted suicide after the index admission. After index, completers had received more psychiatric care and treatment than non-completers. Comorbidity was common in both groups of patients. Personality disorders according to the DSM III-R, axis II, Cluster B, however, tended to be more common in the completer group. Increased comorbidity over time could also be seen to a larger extent in completers. In spite of the matching of principal diagnosis, completers tended to have higher Montgomery–Åsberg Depression Rating Scale ratings than non-completers. They also had significantly higher Suicide Assessment Scale (SUAS) scores. From this study, it is apparent that suicide attempters at risk of future suicide have major and multiple psychiatric problems, which cause difficulties in the care and treatment.     

Are suicide attempters who self-mutilate a unique population?

OBJECTIVE: Individuals who mutilate themselves are at greater risk for suicidal behavior. Clinically, however, there is a perception that the suicide attempts of self-mutilators are motivated by the desire for attention rather than by a genuine wish to die. The purpose of this study was to determine differences between suicide attempters with and without a history of self-mutilation. METHOD: The authors examined demographic characteristics, psychopathology, objective and perceived lethality of suicide attempts, and perceptions of their suicidal behavior in 30 suicide attempters with cluster B personality disorders who had a history of self-mutilation and a matched group of 23 suicide attempters with cluster B personality disorders who had no history of self-mutilation. RESULTS: The two groups did not differ in the objective lethality of their attempts, but their perceptions of the attempts differed. Self-mutilators perceived their suicide attempts as less lethal, with a greater likelihood of rescue and with less certainty of death. In addition, suicide attempters with a history of self-mutilation had significantly higher levels of depression, hopelessness, aggression, anxiety, impulsivity, and suicide ideation. They exhibited more behaviors consistent with borderline personality disorder and were more likely to have a history of childhood abuse. Self-mutilators had more persistent suicide ideation, and their pattern for suicide was similar to their pattern for self-mutilation, which was characterized by chronic urges to injure themselves. CONCLUSIONS: Suicide attempters with cluster B personality disorders who have a history of self-mutilation tend to be more depressed, anxious, and impulsive, and they also tend to underestimate the lethality of their suicide attempts. Therefore, clinicians may be unintentionally misled in assessing the suicide risk of self-mutilators as less serious than it is.     

Is attempted suicide different in adolescent and adults?

Attempted suicide may be a different phenomenon in adolescents than in adults. To our knowledge, direct comparisons between these two populations are very scarce. The aim of this study is to analyze the differences between adolescents and adults in methods of attempted suicide, accompanying certainty of death, and intentionality. All cases admitted to one adult (n=173) and one adolescent (n=104) inpatient unit who attempted suicide in the period from January 2003 through October 2005 were included in a prospective, common, national register, with data on methods, circumstances, and intentionality. The methodology followed that of the WHO/Euro Multicenter Study on Parasuicide. A stratified analysis was performed using the Mantel-Haenszel procedure in order to control for the effects of gender and diagnosis. Adolescents used significantly more over-the-counter medicines. Adults were significantly more certain of the possible fatal outcome of their attempt and had a significantly more severe intention when harming themselves. Individuals appear to use the methods that are available to them to attempt suicide. Adolescents may display more impulsive and less lethal directed behavior than adults or, alternatively, they are more frequently admitted for less severe attempts.     

Are there genetic factors in suicide?

There are generally considered to be five lines of evidence about the possibility that there may be genetic factors in suicide. This paper will review the clinical, Iowa-500, Amish, twin and adoption studies which provide evidence about this possibility.     

Commonalities in epileptogenic processes from different acute brain insults: Do they translate?

The most common forms of acquired epilepsies arise following acute brain insults such as traumatic brain injury, stroke, or central nervous system infections. Treatment is effective for only 60%‐70% of patients and remains symptomatic despite decades of effort to develop epilepsy prevention therapies. Recent preclinical efforts are focused on likely primary drivers of epileptogenesis, namely inflammation, neuron loss, plasticity, and circuit reorganization. This review suggests a path to identify neuronal and molecular targets for clinical testing of specific hypotheses about epileptogenesis and its prevention or modification. Acquired human epilepsies with different etiologies share some features with animal models. We identify these commonalities and discuss their relevance to the development of successful epilepsy prevention or disease modification strategies. Risk factors for developing epilepsy that appear common to multiple acute injury etiologies include intracranial bleeding, disruption of the blood‐brain barrier, more severe injury, and early seizures within 1 week of injury. In diverse human epilepsies and animal models, seizures appear to propagate within a limbic or thalamocortical/corticocortical network. Common histopathologic features of epilepsy of diverse and mostly focal origin are microglial activation and astrogliosis, heterotopic neurons in the white matter, loss of neurons, and the presence of inflammatory cellular infiltrates. Astrocytes exhibit smaller K⁺ conductances and lose gap junction coupling in many animal models as well as in sclerotic hippocampi from temporal lobe epilepsy patients. There is increasing evidence that epilepsy can be prevented or aborted in preclinical animal models of acquired epilepsy by interfering with processes that appear common to multiple acute injury etiologies, for example, in post–status epilepticus models of focal epilepsy by transient treatment with a trkB/PLCγ1 inhibitor, isoflurane, or HMGB1 antibodies and by topical administration of adenosine, in the cortical fluid percussion injury model by focal cooling, and in the albumin posttraumatic epilepsy model by losartan. Preclinical studies further highlight the roles of mTOR1 pathways, JAK‐STAT3, IL‐1R/TLR4 signaling, and other inflammatory pathways in the genesis or modulation of epilepsy after brain injury. The wealth of commonalities, diversity of molecular targets identified preclinically, and likely multidimensional nature of epileptogenesis argue for a combinatorial strategy in prevention therapy. Going forward, the identification of impending epilepsy biomarkers to allow better patient selection, together with better alignment with multisite preclinical trials in animal models, should guide the clinical testing of new hypotheses for epileptogenesis and its prevention.     

Placebo-controlled trials in schizophrenia: are they ethical? Are they necessary?

The current controversy as to the proper role of the placebo control in the evaluation of new treatments for schizophrenia requires an analysis that is sensitive to both ethical and scientific issues. Clinical equipoise, widely regarded as the moral foundation of the randomized controlled trial (RCT), requires the use of best available treatment as the control in RCT. Scientific criticisms of the use of an active control are examined and none present an insuperable barrier to the use of an active control. Indeed, scrutiny of the most recent argument for the use of placebo controls, 'assay sensitivity', suggests that the use of placebo may be the cause of the problem pointed to. Scientific, regulatory, ethical and legal advantages of the use of an active control are described. While the use of a placebo control may be acceptable in carefully defined circumstances, in most cases the use of an active control in schizophrenia research is ethically and scientifically preferable.     

Postmortem μ-opioid receptor binding in suicide victims and controls

Summary. Background: Endogenous opiates may reinforce self-injurious behavior in animal and human subjects. Higher postmortem -opioid receptor binding is reported in some brain regions in young compared with older suicide victims. The present study compared opioid receptor binding kinetics in postmortem brains of young suicide victims and matched controls in two brain areas. Methods: The density (Bmax) and affinity (K_D) of the -opioid receptors were assayed postmortem using [³H] DAGO in prefrontal cortex (PFC) and pre-post central gyri (PPCG) in 9 suicide victims and 10 controls, matched for age and gender ratio. Results: Binding indices did not differ between suicide victims and controls in either brain area and did not correlate with age. PFC Bmax was higher than PPCG Bmax (F=8.030; df=1,16; p=.012) for the combined sample. There was no brain region difference in K_D between PFC and PPCG, but the interaction between K_D and group was significant (F = 5.890; df = 1,16; p = .027). The K_D in the suicide victims was lower than controls in the PFC and higher than controls in the PPCG. Conclusion: Our study demonstrated more -opioid receptors in PFC compared with PPCG binding regardless of suicide status. The region-dependent differences in binding affinity in suicide victims may reflect regionally different opiate transmission.     

Predicting inpatient suicides and suicide attempts by using clinical routine data?

OBJECTIVE: The study aimed at exploring prevalence and risk factors of inpatient suicides and attempted suicides in a psychiatric hospital. METHOD: Based on the German psychiatric basic documentation system, 20,543 patients with 40,451 episodes of inpatient care (1995-2004) in a psychiatric state hospital were included. Besides univariate analyses, multivariate logistic regression analyses and classification and regression tree analyses were performed. RESULTS: Forty-one inpatient suicides were recorded. Risk of inpatient suicide is increased for patients with resistance to psychopharmacological treatment, previous suicide attempt, severe side effects and supportive psychotherapy before admission. Two hundred fourteen inpatient suicide attempts occurred during the 10-year period. Risk factors of inpatient suicide attempt are assault, personality disorder, previous suicide attempt, psychopharmacological treatment resistance, suicidal thoughts at admission, schizophrenia, depression, female sex and length of stay. CONCLUSION: The identified risk factors underline the need for a cautious investigation of previous suicide attempts as well as for giving special attention to patients who have problems with psychopharmacotherapy during hospitalization.     

Celebrity suicide: Did the death of Kurt cobain influence young suicides in Australia?

Abstract

This study examined the total rate of suicide in Australia for young people (aged 15-19 and 20-24 years) for the 30 day period after the announcement of Kurt Cobain's suicide in 1994, comparing with the identical period for the previous five years and accounting for unequal variability in weekends, Mondays and public holidays. The 1994 rates for male suicides for both age groups were lower than for 1992 and 1993, and were more similar to the 1990 rates. Female rates showed a steady small decline over the five years, sustained in 1994. Rates overall showed a reduction in all of the first five, ten and fifteen day rates, compared with previous years. There was no evidence of any increase in deaths from gunshot, the method used by Cobain. The conclusion appears to be that this celebrity suicide had little impact on suicide in young persons in Australia. Possible reasons for this are discussed.     

K-FAST and WRAT-3: are they really different?

The Kaufman Functional Academic Skills Test (K-FAST) was introduced as an alternative to the Wide Range Achievement Test - Revision 3 (WRAT-3). The goal was to provide a measure that would help determine whether individuals have the adequate reading and mathematical skills to function appropriately in society. Fifty-one individuals from neuropsychologically diverse populations were tested using the K-FAST, WRAT-3, and Kaufman Brief Intelligence Test (K-BIT). Strong correlations were found between the various raw and standard scores of the K-FAST and WRAT-3, indicating that the administration of both tests is redundant; and scores on both tests also correlate well with performance on the K-BIT.     

Are GRIK3 (T928G) gene variants in schizophrenia patients different from those intheir first-degree relatives?

We examined whether the GRIK3 (T928G) polymorphic variants in patients with schizophrenia are different from those of their first-degree relatives and healthy controls. The study population was composed of 256 patients with schizophrenia, 305 first-degree relatives of schizophrenia patients and 242 healthy control subjects. The GRIK3 (T928G) polymorphism was determined by restriction fragment length polymorphism. The frequency of the TT genotype was predominant, whereas the GG genotype was rare among all groups. The frequencies of GRIK3 (T928G) genotype distributions in the patients with schizophrenia were similar to those of their relatives. The frequency of the GG genotype was significantly higher in patients than in healthy controls. Similarly, GG genotype distribution in relatives was elevated compared with that in controls, but this value did not reach statistical significance. On the other hand, the subgroups of schizophrenia patients did not show a significant association with the GRIK3 (T928G) gene. It appears that the patients share the same (GRIK3) T928G gene variants with their relatives. One interpretation of our findings is that the relatives are at risk for the development of schizophrenia in the future.     

Are metabolic indices different between drug-naïve first-episode psychosis patients and healthy controls?

OBJECTIVE: To compare glucose and lipid metabolism parameters between drug-na?ve first-episode psychosis (FEP) patients with a diagnosis of schizophrenia spectrum disorder and healthy controls matched for age, ethnicity, and gender. METHOD: Baseline evaluations of fasting glucose and lipid metabolism parameters and the oral glucose tolerance test were performed with FEP patients (n=38), having no more than 10 days of cumulative exposure to antipsychotic medication, and normal community controls (n=36). Analysis of variance (ANOVA) was conducted to examine between group differences. RESULTS: FEP patients did not show a higher prevalence of the precursors to diabetes (impaired fasting glucose, impaired glucose tolerance, insulin resistance), and no significant difference in beta-cell function or lipid profile measures, compared to healthy controls. FEP patients showed a higher waist to hip ratio compared to controls. CONCLUSIONS: FEP patients having a schizophrenia spectrum disorder do not differ from healthy controls, in their baseline measures of glucose and lipid metabolites, nor in the prevalence of diabetes or its precursors, before (or close to) the onset of antipsychotic treatment.     

The suicide beliefs of Jews and Protestants in the UK: how do they differ?

It has been suggested that Protestant culture has become more tolerant towards suicide in the previous century, while Jewish culture has traditionally not condoned suicide. There have been reports that suicide rates are somewhat lower among Jews than among people of Protestant background. We asked whether there were differences between Jews' and Protestants' beliefs about suicide that might relate to these suggestions and reports. Beliefs about suicide were assessed from the Reasons For Living Inventory (RFL), and with questions about the acceptability of suicide in some circumstances. Self-reported suicide ideation and attempts were also assessed. Some religious-cultural differences were found in beliefs about suicide, but not with regard to ideation and behavior. We discussed the relations between differences in belief, and reported differences in suicide prevalence, and suggested that most of the belief differences were consistent with reported patterns of prevalence. Notably, Jews believed more strongly than Protestants that moral-religious objections to suicide were reasons for living, and that suicide was less acceptable in certain circumstances.     

Are suicides in the psychiatric hospital actually more frequent now?

Annual suicide rates in a North German psychiatric hospital between 1975 and 1997 are reported. There is no overall increase. After a peak in the early eighties there was a moderate but steady decrease of the suicide rate whereas the average of the absolute suicide rate remained stable for almost a quarter of a century.