M. Mercedes Perez-Rodriguez

Suicidal ideation and suicide attempts in the United States: 1991–1992 and 2001–2002

The aim of the study is to compare the prevalence of suicidal ideation and attempts in the United States in 1991–1992 and 2001–2002, and identify sociodemographic groups at increased risk for suicidal ideation and attempts. Data were drawn from the National Institute on Alcohol Abuse and Alcoholism 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (n=42 862) and the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (n=43 093), two nationally representative household surveys of non-institutionalized civilians aged 18 years and older, residing in the United States. The lifetime prevalence of suicide attempts remained unchanged in the United States between 1991–1992 and 2001–2002. Specific groups, namely 18- to 24-year-old white and black women, 25- to 44-year-old white women and 45- to 64-year-old Native American men were identified as being at high risk for suicide attempts. Despite prevention and treatment efforts, the lifetime prevalence of suicide attempts remains unchanged. Given the morbidity and mortality associated with suicide attempts, urgent action is needed to decrease the prevalence of suicide attempts in the United States.

Severity of personality disorders and suicide attempt

Objective:  Severity of personality disorders (PDs) may be more useful in estimating suicide risk than the diagnosis of specific PDs. We hypothesized that suicide attempters with severe PD would present more attempts and attempts of greater severity/lethality.

Low plasma cholesterol levels in suicidal males: A gender- and body mass index-matched case-control study of suicide attempters and nonattempters

Findings from animal and human studies suggest an association between low cholesterol levels and suicidal behaviors. The purpose of this case-control study was to test whether cholesterol levels in suicide attempters are lower than in controls without suicide attempt history matched by gender, age, and body mass index (BMI). Suicide attempters (n=177: 68 men and 109 women) and controls (177 blood donors) were assessed. Serum cholesterol levels were significantly lower in suicide attempters than in controls. After gender stratification, the difference remained significant in men, but not in women.

Specific features of suicidal behavior in patients with narcissistic personality disorder

OBJECTIVE Suicidal behavior is a clinically significant but underestimated cause of mortality in narcissistic personality disorder. Currently, there are no reliable estimates of suicidal behavior for this population. The main objective of this study was to test whether or not suicide attempters diagnosed with narcissistic personality disorder are different in terms of impulsivity and expected lethality from suicide attempters with other cluster B personality disorders. METHOD In a sample of 446 suicide attempters, patients with cluster B personality disorder diagnoses (n = 254) as assessed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), version of the International Personality Disorder Examination-Screening Questionnaire (IPDE-SQ) were compared in terms of expected lethality and impulsivity (measured by the Beck Suicidal Intent Scale and the Barratt Impulsiveness Scale, respectively). The subjects were admitted to the emergency departments of the Ramón y Cajal Hospital and the Fundación Jiménez Diaz University Hospital in Madrid, Spain, between January 1999 and January 2003. RESULTS Suicide attempts of subjects diagnosed with narcissistic personality disorder had higher expected lethality than those of subjects without narcissistic personality disorder (t = -4.24, df = 439, P < .001). There were no differences in expected lethality of the attempts when comparing subjects with and without histrionic personality disorder (t = 0.28, df = 439, P = .795), antisocial personality disorder (t = 0.66, df = 439, P = .504), and borderline personality disorder (t = 1.13, df = 439, P = .256), respectively. Suicide attempters diagnosed with narcissistic personality disorder did not significantly differ from suicide attempters without narcissistic personality disorder in terms of impulsivity measures (t = -0.33, df = 442, P = .738), while suicide attempters diagnosed with antisocial personality disorder, histrionic personality disorder, and borderline personality disorder were significantly more impulsive than suicide attempters without these diagnoses (t = -3.96, df = 442, P < .001; t = -3.88, df = 442, P < .001; and t = -7.44, df = 442, P < .001, respectively). CONCLUSIONS Narcissistic personality disorder seems to be a distinct group among cluster B personality disorders with regard to suicidal behavior. In contrast to suicide attempters with other cluster B personality disorders, suicide attempters diagnosed with narcissistic personality disorder are less impulsive and have suicide attempts characterized by higher lethality. These distinctions may offer a basis for targeted therapies aimed at decreasing suicidal risk in patients with narcissistic personality disorder.

Worldwide impact of economic cycles on suicide trends over 3 decades: Differences according to level of development. A mixed effect model study

Objectives To investigate the trends and correlations of gross domestic product (GDP) adjusted for purchasing power parity (PPP) per capita on suicide rates in 10 WHO regions during the past 30 years. Design Analyses of databases of PPP-adjusted GDP per capita and suicide rates. Countries were grouped according to the Global Burden of Disease regional classification system. Data sources World Banks official website and WHOs mortality database. Statistical analyses After graphically displaying PPP-adjusted GDP per capita and suicide rates, mixed effect models were used for representing and analysing clustered data. Results Three different groups of countries, based on the correlation between the PPP-adjusted GDP per capita and suicide rates, are reported: (1) positive correlation: developing (lower middle and upper middle income) Latin-American and Caribbean countries, developing countries in the South East Asian Region including India, some countries in the Western Pacific Region (such as China and South Korea) and high-income Asian countries, including Japan; (2) negative correlation: high-income and developing European countries, Canada, Australia and New Zealand and (3) no correlation was found in an African country. Conclusions PPP-adjusted GDP per capita may offer a simple measure for designing the type of preventive interventions aimed at lowering suicide rates that can be used across countries. Public health interventions might be more suitable for developing countries. In high-income countries, however, preventive measures based on the medical model might prove more useful.

Effects of the D1 dopamine receptor agonist dihydrexidine (DAR-0100A) on working memory in schizotypal personality disorder.

Pharmacological enhancement of prefrontal D1 dopamine receptor function remains a promising therapeutic approach to ameliorate schizophrenia-spectrum working memory deficits, but has yet to be rigorously evaluated clinically. This proof-of-principle study sought to determine whether the active enantiomer of the selective and full D1 receptor agonist dihydrexidine (DAR-0100A) could attenuate working memory impairments in unmedicated patients with schizotypal personality disorder (SPD). We performed a randomized, double-blind, placebo-controlled trial of DAR-0100A (15 mg/150 ml of normal saline administered intravenously over 30 min) in medication-free patients with SPD (n=16) who met the criteria for cognitive impairment (ie, scoring below the 25th percentile on tests of working memory). We employed two measures of verbal working memory that are salient to schizophrenia-spectrum cognitive deficits, and that clinical data implicate as being associated with prefrontal D1 availability: (1) the Paced Auditory Serial Addition Test (PASAT); and (2) the N-back test (ratio of 2-back:0-back scores). Study procedures occurred over four consecutive days, with working memory testing on Days 1 and 4, and DAR-0100A/placebo administration on Days 2–4. Treatment with DAR-0100A was associated with significantly improved PASAT performance relative to placebo, with a very large effect size (Cohen’s d=1.14). Performance on the N-back ratio was also significantly improved; however, this effect rested on both a non-significant enhancement and diminution of 2-back and 0-back performance, respectively; therefore interpretation of this finding is more complicated. DAR-0100A was generally well tolerated, with no serious medical or psychiatric adverse events; common side effects were mild to moderate and transient, consisting mainly of sedation, lightheadedness, tachycardia, and hypotension; however, we were able to minimize these effects, without altering the dose, with supportive measures, eg, co-administered normal saline. Although preliminary, these findings lend further clinical support to the potential of D1 receptor agonists to treat schizophrenia-spectrum working memory impairments. These data suggest a need for further studies with larger group sizes, serum DAR-0100A levels, and a more comprehensive neuropsychological battery.

Differences in maternal and paternal age between Schizophrenia and other psychiatric disorders

Advanced parental age has been shown to increase offspring risk for a number of neuropsychiatric disorders including schizophrenia and Downs syndrome. Other psychiatric disorders have been less studied with respect to the effect of parental age on offspring risk. In this study we examine if advanced parental age increased risk for ICD-10 diagnoses. We hypothesized that advanced parental age would increase risk for offspring psychotic disorders and mental retardation but not other ICD-10 diagnoses. We examined follow-up data for 30,965 subjects treated in outpatient psychiatric facilities between 1980 and 2007. Subjects were younger than 18 years of age at their first outpatient visit. A comparison group was obtained from data on registered births in Spain from 1975. We compared parental age (maternal, paternal, combined) across diagnostic categories using ANOVA and logistic regression was used to estimate the risk of psychopathology in the offspring with advanced parental age (maternal, paternal, combined). Maternal and paternal ages were higher for subjects diagnosed with mental retardation. Risk for psychotic disorders showed a significant linear increase only with advancing maternal age, and not paternal age as is more often reported.

Suicide attempts among women during low estradiol/low progesterone states

The relationship between the menstrual cycle and risk for suicidal behaviors is not clear. The aim of this study is to determine whether perimenstrual phases in fertile women are associated with acute risk for suicide attempt and explore whether risk is elevated during low estradiol/low progesterone states. Women (N=431) recruited within 24h of a suicide attempt were assessed for psychopathology, suicidal behavior and LH, FSH, estradiol and progesterone blood levels. Among fertile women (N=281/431), suicide attempts were more likely to occur during menses (26%, 72/281 observed vs. 15%, 43/281 expected attempts; p<0.001). Compared to women whose attempts occurred during other phases, women who attempted suicide during low estradiol/low progesterone states (menstrual phase, amenorrhea and menopause) reported severe suicide intent, a measure that may be predictive of eventual suicide death. Suicide attempts among women are more likely when estrogen and progesterone levels are low and attempts made under these conditions are associated with greater severity. Low gonadal hormone levels may constitute a key factor in the neurobiological basis of suicidal behavior among women, suggesting a novel, testable hypothesis regarding the underpinnings of suicidal acts.

Suicidal behavior in schizophrenia and depression : A comparison

The aim of this study was to compare the frequencies and suicide attempt characteristics in patients with schizophrenia (N = 25) and major depression in absence of schizophrenia (N = 107). There were no significant differences in attempt methods, but attempters with schizophrenia reported a lower number of life events influencing the attempt (2.0 vs. 2.6), less influence of life events on the attempt (42% vs. 83%) and lower GAF scores (36 vs. 50). Schizophrenia was not associated with higher impulsivity scores but with significantly more lethal attempts (40% vs. 29%) and with a trend toward (p = 0.08) higher scores in aggressive behavior history.

Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison.

BACKGROUND Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. METHODS 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers. RESULTS Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8-67.7), health problems (OR=20.6; 95% CI=5.6-75.9), male sex (OR=9.6; 95% CI=4.42-20.9), and alcohol abuse (OR=5.5; 95% CI=2.3-14.2). LIMITATIONS Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data. CONCLUSIONS Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.