Diminished responses to bodily threat and blunted interoception in suicide attempters

Psychological theories of suicide suggest that certain traits may reduce aversion to physical threat and increase the probability of transitioning from suicidal ideation to action. Here, we investigated whether blunted sensitivity to bodily signals is associated with suicidal action by comparing individuals with a history of attempted suicide to a matched psychiatric reference sample without suicide attempts. We examined interoceptive processing across a panel of tasks: breath-hold challenge, cold-pressor challenge, and heartbeat perception during and outside of functional magnetic resonance imaging. Suicide attempters tolerated the breath-hold and cold-pressor challenges for significantly longer and displayed lower heartbeat perception accuracy than non-attempters. These differences were mirrored by reduced activation of the mid/posterior insula during attention to heartbeat sensations. Our findings suggest that suicide attempters exhibit an ‘interoceptive numbing’ characterized by increased tolerance for aversive sensations and decreased awareness of non-aversive sensations. We conclude that blunted interoception may be implicated in suicidal behavior.

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

Psychological Medicine ◽

10.1017/s0033291714000786 ◽

2014 ◽

Vol 44 (14) ◽

pp. 2965-2974 ◽

Cited By ~ 34

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.

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Characteristics of suicide attempters with a high lethality means

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1804 ◽

2017 ◽

Vol 41 (S1) ◽

pp. s889-s889

Author(s):

C.T. Lee ◽

S.Y. Lee ◽

K.U. Lee ◽

H.K. Lee ◽

Y.S. Kweon

Keyword(s):

Clinical Judgment ◽

Suicide Risk ◽

Suicide Attempts ◽

Demographic Variables ◽

Suicide Attempters ◽

Exact Test ◽

Factors Associated ◽

History Of ◽

Competing Interest ◽

Lethal Means

IntroductionSuicide attempts with higher lethality increase the likelihood of suicide completion. Accumulating knowledge on risk factors contributing to higher suicide lethality may help clinicians to allocate their limited resources to more endangered people.ObjectivesTo explore the factors associated with higher lethality in suicide attempts.MethodsAll suicide attempters, who visited the emergency department of Uijeongbu St. Mary's hospital from January 2014 to December 2015, were reviewed retrospectively. We compared between the high vs. the low lethality group, of which had been recorded based on clinical judgment using t-test or Chi2/Fisher's exact test with two-sided P-value of 0.05.ResultsAmong the 753 suicide attempters, the assessed lethality was recorded in 736 cases. Low and highly lethal attempters were 426 (57.9%) and 310 (42.1%), respectively. For demographic variables, the high lethality attempters were significantly more likely to be older (48.3 vs. 44.78; P = 0.009), unemployed (61.0% vs. 56.5%; P = 0.042, without religion (90.9% vs. 84.9%; P = 0.017). For clinical variables, the high lethality attempters were significantly more likely have hopelessness (67.7% vs. 58.2%; P = 0.013) and a history of schizophrenia (4.5% vs. 1.4%; P = 0.023, while they did display any difference for mood disorders. The low lethality suicide attempts were more frequent in patients with comorbid personality disorders (9.2% vs. 4.9%; P = 0.031).ConclusionsThese results are in line with literatures reporting higher suicide risk in people, who are old, unemployed, not having a religion, psychotic and hopeless. These may have been moderated by committing a higher lethal means of suicide at least in part and warrants additional investigations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462009000200006 ◽

2009 ◽

Vol 31 (2) ◽

pp. 114-118 ◽

Cited By ~ 15

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.

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Temperament traits in male suicide attempters and violent offenders

European Psychiatry ◽

10.1016/s0924-9338(99)00170-4 ◽

1999 ◽

Vol 14 (5) ◽

pp. 278-283 ◽

Cited By ~ 25

Author(s):

G. Engström ◽

B. Persson ◽

S. Levander

Keyword(s):

Suicide Attempts ◽

Violent Offenders ◽

Indirect Aggression ◽

Normal Range ◽

Suicide Attempters ◽

Male Suicide ◽

History Of ◽

High Trait ◽

Temperament Traits ◽

High Trait Anxiety

SummaryWith the purpose of comparing temperament traits in subjects who have been violent towards others and with subjects who have shown self-directed violence, 34 male suicide attempters and 34 male violent offenders were matched for age and psychiatric diagnosis. Violent offenders with a history of suicide attempts were excluded. Temperament traits were assessed by means of the Karolinska Scales of Personality.The temperament profiles of suicide attempters and violent offenders were very similar, with high trait anxiety and very low socialization. Violent offenders displayed significantly higher social desirability (P < 0.001). Suicide attempters tended to have higher indirect aggression and monotony avoidance. Impulsiveness, verbal aggression, and inhibition of aggression were within the normal range in both groups. There were substantial temperamental similarities between suicide attempters and violent offenders. In order to disentangle the differential mechanisms behind aggression towards self and others, we probably need to consider historical as well as current situation factors in a systematic way.

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Suicide attempts in bulimia nervosa: Personality and psychopathological correlates

European Psychiatry ◽

10.1016/j.eurpsy.2008.10.002 ◽

2009 ◽

Vol 24 (2) ◽

pp. 91-97 ◽

Cited By ~ 40

Author(s):

Laura Forcano ◽

Fernando Fernández-Aranda ◽

Eva Álvarez-Moya ◽

Cynthia Bulik ◽

Roser Granero ◽

...

Keyword(s):

Eating Disorder ◽

Alcohol Abuse ◽

Bulimia Nervosa ◽

Suicide Attempts ◽

Future Research ◽

Strongly Correlated ◽

Suicide Attempters ◽

General Psychopathology ◽

History Of Childhood ◽

History Of

AbstractBackgroundLittle evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.MethodFive hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.ResultsLifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).ConclusionOur results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.

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Suicide attempters: Clinical characteristics and management

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2242 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S601-S601

Author(s):

E. Gattoni ◽

A. Feggi ◽

C. Gramaglia ◽

P. Bergamasco ◽

I. Coppola ◽

...

Keyword(s):

Depressive Symptoms ◽

Suicide Attempt ◽

Clinical Characteristics ◽

Depressive Disorders ◽

Attempted Suicide ◽

Rating Scale ◽

Suicide Attempts ◽

Suicidal Risk ◽

Suicide Attempters ◽

History Of

BackgroundSuicide attempts, defined as self-inflicted, potentially injurious behaviors with a nonfatal outcome, and with evidence of intent to die are extremely prevalent. Literature suggests that suicide is more common among males, while attempted suicide is more frequent among females. Depression, mental disorders, substance use disorders and history of suicidal behavior are important risk factors for suicide: the risk of suicide attempt is 3 to 12 times higher in psychiatric patients than in the general population.AimThe aim of our study was to compare severity of depressive symptoms in a sample of suicide attempters with a diagnosis of bipolar and related disorders or depressive disorders and in a sample of sex- and diagnosis-matched patients who do not commit a suicide attempt. The severity of attempted suicide and the suicidal risk in the hospital will be assessed as well.Material and methodsWe collected a sample of inpatients who committed a suicide attempt during 2015. For each attempter, we selected another sex- and diagnosis-matched patient with no history of attempted suicide. Socio-demographic and clinical characteristics of the sample were gathered. Assessment included: Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depressive symptoms in both groups, Suicide Intent Scale (SIS) for the severity of attempted suicide and the suicidal risk with a nurse assessment for suicide.ResultsData collecting is still ongoing. We expected to find more severe symptoms in patients who attempted suicide. Clinical implication will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Prolactin Response to Fenfluramine and Suicide Attempt Lethality in Major Depression

The British Journal of Psychiatry ◽

10.1192/bjp.168.3.324 ◽

1996 ◽

Vol 168 (3) ◽

pp. 324-329 ◽

Cited By ~ 100

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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Attempted Suicide in Young Women: Correlates of Lethality

The British Journal of Psychiatry ◽

10.1192/bjp.139.5.382 ◽

1981 ◽

Vol 139 (5) ◽

pp. 382-390 ◽

Cited By ~ 34

Author(s):

Robert D. Goldney

Keyword(s):

Young Women ◽

Attempted Suicide ◽

Suicide Attempts ◽

Economic Status ◽

Schizoid Personality ◽

Physical Threat ◽

History Of ◽

History Of Violence ◽

High Degree ◽

Threat To Life

SummaryOne hundred and ten young women aged 18 to 30 years who had attempted suicide by drug overdose were divided into three groups on the basis of the physical threat to life of their suicide attempt. Young women whose suicide attempts resulted in the greatest risk to life were more often unmarried or not in a de facto relationship; reported little use of alcohol; had had recent contact with a psychiatrist; had taken more than 20 tablets or capsules, most often antidepressants; and had a high degree of suicidal intent and hopelessness. Furthermore, there were trends for them to be of high socio-economic status; to have had less history of violence, both used and sustained; to more often demonstrate schizoid personality traits; and to report less death anxiety.

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Marked increases in psychopathology found in a 30-year cohort comparison of suicide attempters

Psychological Medicine ◽

10.1017/s0033291703001867 ◽

2004 ◽

Vol 34 (5) ◽

pp. 833-841 ◽

Cited By ~ 14

Author(s):

G. R. HENRIQUES ◽

G. K. BROWN ◽

M. S. BERK ◽

A. T. BECK

Keyword(s):

Public Health ◽

Drug Use ◽

Illicit Drug ◽

Suicide Attempts ◽

Epidemiological Studies ◽

Suicide Attempters ◽

Suicide Intent ◽

History Of ◽

Major Variable ◽

Over Time

Background. Although several epidemiological studies have found increases in the percentages of people who have made a suicide attempt, few cohort comparisons have been conducted to determine changes within this population over time. The purpose of this investigation was to determine if there have been changes in the clinical profile of suicide attempters in recent decades.Method. Comparisons between a sample of 258 suicide attempters evaluated between 1970 and 1973 and a second sample of 179 suicide attempters evaluated between 1999 and 2002 were made on depression, hopelessness, suicide intent, drug use, history of suicide attempts and subsequent suicide attempts.Results. Present-day suicide attempters were found to exhibit greater levels of depression (p=0·031), hopelessness (p=0·008), suicide intent (p<0·001), and had much higher rates of illicit drug use (p<0·001). Almost twice as many of the present-day suicide attempters had histories of four or more suicide attempts (p<0·001), and the present-day suicide attempters made subsequent suicide attempts at close to four times the rate in the year following the index attempt (p<0·001).Conclusions. The present-day suicide attempters exhibited greater levels of psychopathology on every major variable assessed. Replication is necessary and public health implications are discussed.

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Paralimbic and lateral prefrontal encoding of reward value during intertemporal choice in attempted suicide

Psychological Medicine ◽

10.1017/s0033291715001890 ◽

2015 ◽

Vol 46 (2) ◽

pp. 381-391 ◽

Cited By ~ 16

Author(s):

P. M. Vanyukov ◽

K. Szanto ◽

M. N. Hallquist ◽

G. J. Siegle ◽

C. F. Reynolds ◽

...

Keyword(s):

Suicidal Behavior ◽

Intertemporal Choice ◽

Suicide Attempts ◽

Preliminary Evidence ◽

Posterior Cingulate Cortex ◽

Suicide Attempters ◽

Subjective Value ◽

History Of ◽

Medication Exposure ◽

Neural Underpinnings

BackgroundAlongside impulsive suicide attempts, clinicians encounter highly premeditated suicidal acts, particularly in older adults. We have previously found that in contrast to the more impulsive suicide attempters’ inability to delay gratification, serious and highly planned suicide attempts were associated with greater willingness to wait for larger rewards. This study examined neural underpinnings of intertemporal preference in suicide attempters. We expected that impulsivity and suicide attempts, particularly poorly planned ones, would predict altered paralimbic subjective value representations. We also examined lateral prefrontal and paralimbic correlates of premeditation in suicidal behavior.MethodA total of 48 participants aged 46–90 years underwent extensive clinical and cognitive characterization and completed the delay discounting task in the scanner: 26 individuals with major depression (13 with and 13 without history of suicide attempts) and 22 healthy controls.ResultsMore impulsive individuals displayed greater activation in the precuneus/posterior cingulate cortex (PCC) to value difference favoring the delayed option. Suicide attempts, particularly better-planned ones, were associated with deactivation of the lateral prefrontal cortex (lPFC) in response to value difference favoring the immediate option. Findings were robust to medication exposure, depression severity and possible brain damage from suicide attempts, among other confounders. Finally, in suicide attempters longer reward delays were associated with diminished parahippocampal responses.ConclusionsImpulsivity was associated with an altered paralimbic (precuneus/PCC) encoding of value difference during intertemporal choice. By contrast, better-planned suicidal acts were associated with altered lPFC representations of value difference. The study provides preliminary evidence of impaired decision processes in both impulsive and premeditated suicidal behavior.

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