C. van Heeringen

Cloninger's psychobiological model of temperament and character and the five-factor model of personality.

The relationships between Cloninger’s Temperament and Character dimensions [Cloninger, C. R. (1987). A systematic method for clinical description and classification of personality variants. Archives of General Psychiatry, 44 573‐588; Cloninger, C. R., Svrakic, D. M., & Przybeck, T. R. (1993). A psychobiological model of temperament and character. Archives of General Psychiatry, 50, 975‐990] and the Five-Factor Model (FFM) of personality are investigated in a randomised sample of 130 patients admitted to the Emergency Psychiatric Unit of a large university hospital. Cloninger’s psychobiological model identifies four dimensions of temperament (Novelty seeking, Harm avoidance, Reward dependence and Persistence) and three dimensions of character (Self-directedness, Cooperativeness and Self-transcendence). The FFM proposes the domains of Extraversion, Agreeableness, Conscientiousness, Neuroticism and Openness as the basic dimensions underlying individual diAerences. Five-factor scores are obtained with the NEO-PI-R [Costa, P. T., Jr., & McCrae, R. R. (1992). NEO-PI-R. Professional manual. Odessa, FL: Psychological Assessment Resources]; Cloninger’s personality dimensions are assessed with the Temperament and Character Inventory (Cloninger et al., 1993). The present study primarily focuses on the direct equivalence of Cloninger’s scales with the NEO-PI-R domains and facets. Considerable overlap with the FFM dimensions is demonstrated and the results show that each TCI factor is substantially covered by the FFM. 7 2000 Elsevier Science Ltd. All rights reserved.

Prefrontal 5-HT2a receptor binding index, hopelessness and personality characteristics in attempted suicide

BACKGROUND Depression, hopelessness, impaired problem solving capacities and deficient serotonergic functions have been identified as major causes of suicidal behaviour. In general, the relation between biological markers of attempted suicide and psychological functions has been investigated using indirect peripheral markers of, e.g. the serotonergic system. Recently, functional neuroimaging techniques with radioligands allow direct in vivo assessment of the neurobiological status of the central nervous system. METHODS We studied the binding index of serotonin-(2a) (5-HT(2a)) receptors in the frontal cortex of attempted suicide patients (n=9) and normal controls (n=13) using [123I]5-I-R91150, a highly selective 5-HT(2a) receptor ligand. Moreover, we measured personality characteristics (using Cloningers Temperament and Character Inventory) and levels of hopelessness (using Becks Hopelessness Scale), and studied the association between 5-HT(2a) receptor binding index, hopelessness and these personality dimensions. RESULTS When compared to normal controls, attempted suicide patients had a significantly lower binding potential of frontal 5-HT(2a) receptors, a higher level of hopelessness, a higher score on the temperament dimension harm avoidance and lower scores on the character dimensions self-directedness and cooperativeness. A significant correlation was found between harm avoidance, hopelessness and binding index in the population of patients that attempted suicide. LIMITATIONS The limited number of patients and potential ingestion of psychotropic drugs may influence the results of the study. CONCLUSIONS Lower central serotonergic function, hopelessness and harm avoidance are interrelated phenomena, which may increase the probability of the occurrence of attempted suicide.

The effects of mindfulness-based cognitive therapy on recurrence of depressive episodes, mental health and quality of life: A randomized controlled study

Depression is characterized by a large risk of relapse/recurrence. Mindfulness-based cognitive therapy (MBCT) is a recent non-drug psychotherapeutic intervention to prevent future depressive relapse/recurrence in remitted/recovered depressed patients. In this randomized controlled trial, the authors investigated the effects of MBCT on the relapse in depression and the time to first relapse since study participation, as well as on several mood states and the quality of life of the patients. 106 recovered depressed patients with a history of at least 3 depressive episodes continued either with their treatment as usual (TAU) or received MBCT in addition to TAU. The efficacy of MBCT was assessed over a study period of 56 weeks. At the end of the study period relapse/recurrence was significantly reduced and the time until first relapse increased in the MBCT plus TAU condition in comparison with TAU alone. The MBCT plus TAU group also showed a significant reduction in both short and longer-term depressive mood and better mood states and quality of the life. For patients with a history of at least three depressive episodes who are not acutely depressed, MBCT, added to TAU, may play an important role in the domain of relapse prevention in depression.

The management of non-compliance with referral to out-patient after-care among attempted suicide patients: a controlled intervention study

The failure to comply with referral for out-patient after-care is a well-documented problem among attempted suicide patients. The present study aimed at the investigation of an experimental referral procedure by means of a randomized controlled study. Non-compliant patients in the experimental group were visited in their homes by a community nurse in order to assess reasons for non-compliance and to motivate patients to comply with referral. One year after their suicide attempt patients were visited in their homes in order to assess repetition of suicidal behaviour. Uni- and multi-variate analyses showed a significant beneficial effect of the experimental procedure on compliance with referral. A near-significant effect of the experimental procedure on the rate of repetition of suicidal behaviour was found.

Suicidal acts and ideation in homosexual and bisexual young people: a study of prevalence and risk factors.

Abstract  Background: Suicide attempts are the most robust clinical predictor of suicide, which is now the second cause of death among young people in many countries. Previous research has shown an increased risk of attempted suicide associated with a homosexual orientation. However, the mechanisms underlying this increased risk are not yet clear. This study therefore aimed to determine the risk of attempted suicide and the effect of potential risk factors on the occurrence of suicidal ideation and behaviour among homosexual youngsters. Methods: The association between suicidal ideation and behaviour and potential risk factors was assessed by means of a questionnaire in a general population sample of homosexual or bisexual young people and a control sample consisting of school pupils. Results: A twofold increased risk of suicidal ideation was found associated with a homosexual or bisexual orientation. A significantly increased risk of attempted suicide associated with homosexuality or bisexuality was found in females. Independent of sexual orientation, depression was identified as a significant risk factor for suicidal ideation, while suicidal behaviour was associated with low self-esteem, higher levels of hopelessness and suicidal behaviour in someone close. Among homosexual or bisexual young people, less satisfying homosexual friendships were an additional risk factor for suicidal behaviour. Conclusions: The identified increased risk of suicidal ideation among homosexual or bisexual young people is associated with depression and may lead to suicidal behaviour, independent of sexual orientation, especially in the presence of a role model of suicidal behaviour, and among those with unsatisfying friendships.

Suicidal brains: A review of functional and structural brain studies in association with suicidal behaviour

Evidence of an association between a vulnerability to suicidal behaviour and neurobiological abnormalities is accumulating. Post-mortem studies have demonstrated structural and biochemical changes in the brains of suicide victims. More recently, imaging techniques have become available to study changes in the brain in vivo. This systematic review of comparative imaging studies of suicidal brains shows that changes in the structure and functions of the brain in association with suicidal behaviour are mainly found in the orbitofrontal and dorsolateral parts of the prefrontal cortex. Correlational studies suggest that these changes relate to neuropsychological disturbances in decision-making, problem solving and fluency, respectively. As a consequence, the findings from these studies suggest that suicidal behaviour is associated with (1) a particular sensitivity to social disapproval (2) choosing options with high immediate reward and (3) a reduced ability to generate positive future events. Further study is needed to elaborate these findings and to investigate to what extent changes in the structure and function of suicidal brains are amenable to psychological and/or biological interventions.

Structural and functional neuroimaging studies of the suicidal brain

Suicidality is a major challenge for todays health care. Evidence suggests that there are differences in cognitive functioning of suicidal patients but the knowledge about the underlying neurobiology is limited. Brain imaging offers the advantage of a non-invasive in vivo direct estimation of detailed brain structure, regional brain functioning and estimation of molecular processes in the brain. We have reviewed the literature on neuroimaging studies of the suicidal brain. This article contains studies on structural imaging such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) and functional imaging, consisting of Positron Emission Tomography (PET), Single Photon Emission Tomography (SPECT) and functional MRI (fMRI). We classified the results of the different imaging modalities in structural and functional imaging. Within our research, we found no significant differences in the suicidal brain demonstrated by Computed Tomography. Magnetic Resonance Imaging studies in subjects with a history of suicide attempt on the other hand deliver differing results, mostly pointing at a higher prevalence of white (especially deep white matter and periventricular) and grey matter hyperintensities in the frontal, temporal and/or parietal lobe and decreased volumes in the frontal and temporal lobe. There seems to be a trend towards findings of reduced grey matter volume in the frontal lobe. Overall, there is no consensus of opinion on structural imaging of the suicidal brain. Research on functional imaging is further divided into studies in resting state, studies in activation conditions and studies on brain neurotransmitters, transporters and receptors. A common finding in functional neuroimaging in resting conditions is a decreased perfusion in the prefrontal cortex of suicidal patients. During cognitive activation, perfusion deficits in the prefrontal cortex have been observed. After fenfluramine challenge, the prefrontal cortex metabolism seems to be inversely correlated to the lethality of previous suicide attempt. The few studies that examined the serotonin transporter in suicide found no significant differences in binding potential. In suicide attempters there seems to be a negative correlation between impulsivity and SERT binding. Our group found a reduced 5-HT(2A) binding in the frontal cortex in patients with a recent suicide attempt. The binding index was significantly lower in the deliberate self injury patients compared to the deliberate self poisoning patients. The few authors that examined DAT binding in suicide found no significant DAT differences between patients and controls. However they demonstrated significant negative correlations between DAT binding potential and mental energy among suicide attempters, but not in healthy control subjects. We did not find studies measuring the binding potential of the noradrenalin or gamma amino butyric acid transporter or receptor in suicidal subjects. Several reports have suggested abnormalities of GABA neurotransmission in depression. During our literature search, we have focused on neuroimaging studies in suicidal populations, but in the absence of evidence in the literature on this group or when further collateral evidence is appropriate, this overview expands to results in impulsive aggressive or in depressed subjects.

Suicide rates in the world: Update

Suicide rates in the world: Update A. Schmidtkea; B. Weinackera; A. Aptera; A. Batta; A. Bermana; U. Bille-brahea; A. Botsisa; D. De Leoa; A. Doneuxa; R. Goldneya; O. Grada; C. Haringa; K. Hawtona; H. Hjelmelanda; M. Kellehera; A. Kerkhofa; A. Leenaarsa; J. Lonnqvista; K. Michela; A. Ostamoa; E. Salander-renberga; I. Sayila; Y. Takahashia; C. Van Heeringena; A. Varnika; D. Wassermana a Adolescent Unit, Gehah Psychiatric Hospital, The Beilinson Medical Center, Tel-Aviv University Medical School, PO Box 120, 49100 Petah, Tiqva, Israel

Suicide, Serotonin, and the Brain

The involvement of impaired serotonergic functioning in the development of suicidal behavior is one of the best documented findings in biological psychiatry. It is, however, less clear in which way this dysfunction contributes to the occurrence of suicidal behavior. Correlational studies have demonstrated associations between peripheral measures of serotonergic function and characteristics such as impulsivity, disinhibition, anxiety, and/or behavioral inhibition. Postmortem and neuroimaging studies have provided insight in the localization of serotonergic dysfunction in the central nervous system. Nevertheless, results in this area of research have also been contradictory. Following a short overview of recent research findings on serotonin and suicidal behavior, this paper focuses on the involvement of the prefrontal cortex of the brain in the development of suicidal behavior and on the role of serotonin in its executive functions. Based on these considerations, suggestions for future research are discussed.

Strategies to increase compliance with out-patient aftercare among patients referred to a psychiatric emergency department: a multi-centre controlled intervention study.

BACKGROUND Compliance with referral for out-patient aftercare of psychiatric emergency patients is limited. This study investigated the efficacy of a combination of several referral strategies (fixed appointment, involvement of the family, presence of the aftercare person, motivational counselling) in increasing referral and treatment compliance of patients referred to the psychiatric emergency department of three general hospitals. METHODS A randomized controlled design was used to assess the effect of this experimental condition on referral compliance and on continuation of aftercare treatment. RESULTS A significant beneficial effect on compliance with the referral was found in two hospitals and a near-significant effect in the third. After 3 months of aftercare, the influence of the experimental procedure on adherence to therapy was still significant in two hospitals, but not in the third. CONCLUSIONS Helping the patient to attend an initial appointment can be achieved by a combination of practical and organizational arrangements.