Aggressiveness, not impulsiveness or hostility, distinguishes suicide attempters with major depression

2006 ◽  
Vol 36 (12) ◽  
pp. 1779-1788 ◽  
Author(s):  
JOHN G. KEILP ◽  
MARIANNE GORLYN ◽  
MARIA A. OQUENDO ◽  
BETH BRODSKY ◽  
STEVEN P. ELLIS ◽  
...  
Keyword(s):  
Major Depression ◽  
Suicidal Behavior ◽  
Borderline Personality ◽  
Biological Research ◽  
Major Depressive ◽  
Suicide Attempters ◽  
Large Numbers ◽  
History Of ◽  
Patient Subgroups ◽  
The Ideal

Background. Impulsiveness, hostility and aggressiveness are traits associated with suicidal behavior, but also with borderline personality disorder (BPD). The presence of large numbers of BPD subjects in past attempter samples may distort the relative importance of each of these traits to predicting suicidal behavior, and lead to prospective, biological and genetic models that systematically misclassify certain subpopulations of suicidal individuals.Method. Two hundred and seventy-five subjects with major depressive disorder (MDD), including 87 with co-morbid BPD (69 past suicide attempters, 18 non-attempters) and 188 without BPD (76 attempters, 112 non-attempters) completed standard impulsiveness, hostility and aggressiveness ratings. Differences between past suicide attempters and non-attempters were examined with the sample stratified by BPD status.Results. As expected, BPD subjects scored significantly higher than non-BPD subjects on all three trait measures. Stratifying by BPD status, however, eliminated attempter/non-attempter differences in impulsiveness and hostility in both patient subgroups. Past suicide attempters in each of the two subgroups of patients were only distinguished by higher levels of aggressiveness.Conclusions. Once BPD is accounted for, a history of aggressive behavior appears to be the distinguishing trait characteristic of suicide attempters with major depression, rather than global personality dimensions such as impulsiveness or hostility. Aggressiveness, and not these related traits, may be the ideal target for behavioral, genetic and biological research on suicidal behavior, as well as for the clinical assessment of suicide risk.

scholarly journals Neuropsychological function and suicidal behavior: attention control, memory and executive dysfunction in suicide attempt

2012 ◽  
Vol 43 (3) ◽  
pp. 539-551 ◽  
Author(s):  
J. G. Keilp ◽  
M. Gorlyn ◽  
M. Russell ◽  
M. A. Oquendo ◽  
A. K. Burke ◽  
...  
Keyword(s):  
Working Memory ◽  
Healthy Volunteers ◽  
Suicidal Behavior ◽  
Executive Dysfunction ◽  
Attention Control ◽  
Type I ◽  
Language Fluency ◽  
Major Depressive ◽  
Suicide Attempters ◽  
History Of

BackgroundExecutive dysfunction, distinct from other cognitive deficits in depression, has been associated with suicidal behavior. However, this dysfunction is not found consistently across samples.MethodMedication-free subjects with DSM-IV major depressive episode (major depressive disorder and bipolar type I disorder) and a past history of suicidal behavior (n = 72) were compared to medication-free depressed subjects with no history of suicidal behavior (n = 80) and healthy volunteers (n = 56) on a battery of tests assessing neuropsychological functions typically affected by depression (motor and psychomotor speed, attention, memory) and executive functions reportedly impaired in suicide attempters (abstract/contingent learning, working memory, language fluency, impulse control).ResultsAll of the depressed subjects performed worse than healthy volunteers on motor, psychomotor and language fluency tasks. Past suicide attempters, in turn, performed worse than depressed non-attempters on attention and memory/working memory tasks [a computerized Stroop task, the Buschke Selective Reminding Task (SRT), the Benton Visual Retention Test (VRT) and an N-back task] but not on other executive function measures, including a task associated with ventral prefrontal function (Object Alternation). Deficits were not accounted for by current suicidal ideation or the lethality of past attempts. A small subsample of those using a violent method in their most lethal attempt showed a pattern of poor executive performance.ConclusionsDeficits in specific components of attention control, memory and working memory were associated with suicidal behavior in a sample where non-violent attempt predominated. Broader executive dysfunction in depression may be associated with specific forms of suicidal behavior, rather than suicidal behavior per se.

Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity

2013 ◽  
Vol 28 (8) ◽  
pp. 463-468 ◽  
Author(s):  
J.M. Azorin ◽  
A. Kaladjian ◽  
M. Adida ◽  
E. Fakra ◽  
R. Belzeaux ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Age At Onset ◽  
Borderline Personality ◽  
First Episode ◽  
Contributory Factor ◽  
Structured Interviews ◽  
Major Depressive ◽  
History Of ◽  
Depressive Patients

AbstractObjectiveTo analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.MethodsAs part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−).ResultsCompared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.ConclusionsThe hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.

scholarly journals Neuropsychological deficits in past suicide attempters with varying levels of depression severity

2014 ◽  
Vol 44 (14) ◽  
pp. 2965-2974 ◽  
Author(s):  
J. G. Keilp ◽  
S. R. Beers ◽  
A. K. Burke ◽  
N. M. Melhem ◽  
M. A. Oquendo ◽  
...  
Keyword(s):  
Working Memory ◽  
Major Depression ◽  
Rating Scale ◽  
Suicide Attempts ◽  
Past History ◽  
Clinical State ◽  
Suicide Attempters ◽  
History Of ◽  
Attention Memory ◽  
Interference Processing

BackgroundOur previous work identified deficits in interference processing and learning/memory in past suicide attempters who were currently depressed and medication-free. In this study, we extend this work to an independent sample studied at various stages of illness and treatment (mild symptoms, on average) to determine if these deficits in past suicide attempters are evident during a less severe clinical state.MethodA total of 80 individuals with a past history of major depression and suicide attempt were compared with 81 individuals with a history of major depression and no lifetime suicide attempts on a battery of neurocognitive measures assessing attention, memory, abstract/contingent learning, working memory, language fluency and impulse control.ResultsPast attempters performed more poorly in attention, memory and working memory domains, but also in an estimate of pre-morbid intelligence. After correction for this estimate, tests that had previously distinguished past attempters – a computerized Stroop task and the Buschke Selective Reminding Test – remained significantly worse in attempters. In a secondary analysis, similar differences were found among those with the lowest levels of depression (Hamilton Depression Rating Scale score <10), suggesting that these deficits may be trait markers independent of current symptomatology.ConclusionsDeficits in interference processing and learning/memory constitute an enduring defect in information processing that may contribute to poor adaptation, other higher-order cognitive impairments and risk for suicidal behavior.

A History of Major Depressive Disorder Influences Intent to Die in Violent Suicide Attempters

2004 ◽  
Vol 65 (5) ◽  
pp. 690-695 ◽  
Author(s):  
Bernard Astruc ◽  
Stephane Torres ◽  
Fabrice Jollant ◽  
Sophie Jean-Baptiste ◽  
Didier Castelnau ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Major Depressive ◽  
Suicide Attempters ◽  
History Of

scholarly journals Bipolar disorder first episode and suicidal behavior: are there differences according to type of suicide attempt?

2009 ◽  
Vol 31 (2) ◽  
pp. 114-118 ◽  
Author(s):  
Fernando Silva Neves ◽  
Leandro Fernandes Malloy-Diniz ◽  
Izabela Guimarães Barbosa ◽  
Paulo Marcos Brasil ◽  
Humberto Corrêa
Keyword(s):  
Bipolar Disorder ◽  
Logistic Regression ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
First Episode ◽  
Mean Square ◽  
Suicide Attempters ◽  
Lifetime History ◽  
Bipolar Ii ◽  
History Of

OBJECTIVE: The objective of this study was to test the hypothesis that the polarity of the first mood episode may be a marker for suicidal behavior, particularly the violent subtype. METHOD: One hundred and sixty-eight patients diagnosed with bipolar disorder (DSM-IV) were grouped according to type of first episode: depression or manic/hypomanic. Groups were compared for demographic and clinical variables. We performed logistic regression in order to test the association between first episode polarity and suicidal behavior. RESULTS: We found that depressed patients have a lifetime history of more suicide attempts. However, univariate analysis of number of suicide attempts showed that the best model fits the bipolar II subtype (mean square = 15.022; p = 0.010) and lifetime history of psychotic episodes (mean square = 17.359; p = 0.021). Subgrouping the suicide attempts by subtype (violent or non-violent) revealed that manic/hypomanic patients had a greater tendency toward attempting violent suicide (21.2 vs. 14.7%, X² = 7.028, p = 0.03). Multiple logistic regression analysis confirmed this result. CONCLUSION: Depressed patients had more suicide attempts over time, which could be explained by the higher prevalence of bipolar II subtype in this group, whereas manic/hypomanic patients had a lifelong history of more frequent violent suicide attempts, not explained by any of the variables studied. Our results support the evidence that non-violent suicide attempters and violent suicide attempters tend to belong to different phenotypic groups.

The rat hippocampus as a target for prolonged stress: Biochemical and behavioral effects

1995 ◽  
Vol 7 (2) ◽  
pp. 70-74
Author(s):  
H.J. Krugers ◽  
J. Korf
Keyword(s):  
Risk Factors ◽  
Major Depression ◽  
Major Depressive Episode ◽  
Stressful Life Events ◽  
Previous History ◽  
Endogenous Depression ◽  
Major Depressive ◽  
History Of ◽  
Parental Rearing ◽  
Prolonged Stress

The probability that an individual will suffer from a major depressive episode is often considered to be influenced by risk factors such as gender, premature parental loss, exposure to pathogenic parental rearing, personality, a history of traumatic events, a previous history of major depression, low social support, recent stressful life events and difficulties and predisposing genetic influences. Although several studies suffer from methodological limitations, major depression (endogenous depression) is regarded as a multifactorial disorder and understanding its etiology requires the rigorous integration of several risk factors.

scholarly journals Research on serotonin and suicidal behavior: neuroendocrine and molecular approaches

2002 ◽  
Vol 4 (4) ◽  
pp. 408-416
Keyword(s):  
Major Depression ◽  
Suicide Attempt ◽  
Gene Polymorphism ◽  
Psychiatric Disorder ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Healthy Controls ◽  
Molecular Approaches ◽  
History Of ◽  
Serotonergic Function

We carried out two studies to test the hypothesis that altered central serotonergic function, as assessed by lower prolactin (PRL) response to fenfluramine (D-FEN), is more closely associated with suicidal behavior than a particular psychiatric diagnosis. A D-FEN test was performed in 85 major depressed inpatients, 33 schizophrenic inpatients, and 18 healthy controls. We showed that PRL response to D-FEN is a marker of suicidality, regardless of psychiatric disorder. We then examined the association en the serotonin (5-hydroxytryptamine) receptor 5-HT(2A) gene polymorphism (T102C) and suicide in a sample of Brazilian psychiatric inpatients (95 with schizophrenia, 78 with major depression) and 52 healthy controls. No differences were found in genotypic frequencies across patients and controls. Overall, no differences were found between patients with (n=66) and without (n=107) a history of suicide attempt. We also compared patients with a history of severe suicide attempts (lethality>3; n=32) and patients without such a history (n=107), but they did not exhibit different genotypic frequencies either. These results show thai the 5-HT(2A) gene polymorphism (T102C) may not be involved in the genetic susceptibility to suicidal behavior.

scholarly journals Altered Levels of Neurotrophic Factors in Alzheimer's Disease Patients with a Lifetimne History of Depression

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M.A. Rapp ◽  
V. Haroutunian ◽  
A. Heinz
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Major Depression ◽  
Neurotrophic Factors ◽  
Major Depressive ◽  
Neurotrophin 3 ◽  
Co Morbidity ◽  
History Of ◽  
Underlying Mechanisms ◽  
History Of Depression

Aims:We have recently shown both increases in the number of neuropathological changes in Alzheimer's disease patients with a history of recurrent major depression, and evidence for Alzheimer's disease-related neuropathological changes in patients with geriatric major depression. However, the correlates and possible underlying mechanisms for these neuropathological changes in Alzheimer's disease patients as a function of depression remains to be studied.Method:Levels of several neurotrophic factors, including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin-3 (NT-3) were measured in a sample of Alzheimer's disease patients with and without a lifetime history of major depressive disorder.Results:Alzheimer's disease patients with co-morbid depression showed lower levels BDNF (P < .001) and NGF (P < .001) than Alzheimer's disease patients without co-morbid depression. Results remained stable when controlling for age, gender, level of education, and other medical co-morbidities.Conclusion:In Alzheimer's disease, the presence of depression co-morbidity corresponds to decreases in neurotrophic factors beyond effects of age, education, and medical co-morbidities, suggesting that the previously described link between major depression and the neuropathological processes in Alzheimer's disease may be related to changes in neuronal survival mediated by neurotrophic factors.Funded by the National Institute on Aging (U01 AG016976 and NIA P01-AG05138) and NARSAD.

Prolactin Response to Fenfluramine and Suicide Attempt Lethality in Major Depression

1996 ◽  
Vol 168 (3) ◽  
pp. 324-329 ◽  
Author(s):  
Kevin M. Malone ◽  
Elizabeth M. Corbitt ◽  
Shuhua Li ◽  
J. John Mann
Keyword(s):  
Suicide Attempt ◽  
Suicide Attempts ◽  
Challenge Test ◽  
Major Depressive ◽  
Suicide Attempters ◽  
Lifetime History ◽  
Serotonin System ◽  
History Of ◽  
Serotonergic Function ◽  
Prolactin Response

BackgroundThis study employed an alternative method for assessing serotonergic function to further evaluate our finding that cerebrospinal fluid (CSF) 5-hydroxyindole acetic acid (5-HIAA) in depressed suicide attempters with a lifetime history of higher lethality suicide attempts is significantly lower compared to depressed patients who have a history of low lethality suicide attempts.MethodWe used dl-fenfluramine (60 mg) as a neuroendocrine probe to examine the serotonin system in 41 in-patients with a DSM–III–R major depressive episode, divided into two groups on the basis of a lifetime history of high or low lethality suicide attempts. Fenfluramine challenge test outcome was defined as the maximum prolactin response in the five hours following fenfluramine.ResultsPatients with a history of a higher lethality suicide attempt had a significantly lower prolactin response to fenfluramine, even when controlling for cortisol, age, sex, weight, comorbid cluster B personality disorder, pharmacokinetic and menstrual cycle effects.ConclusionsThe data provide further support for the hypothesis that serotonin dysfunction is associated with more lethal suicide attempts, and suggests that higher lethality suicide attempters or failed suicides resemble completed suicides both behaviourally and biochemically.

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