Makiko Nakagawa

Dopamine D2 receptor gene polymorphisms are associated with suicide attempt in the Japanese population.

Background: Some reports have suggested the involvement of the D2 dopaminergic function in the expression of suicidal behavior. Here, we examined associations between suicide attempts and two kinds of functional polymorphisms in the dopamine D2 receptor (DRD2) gene, namely, TaqIA and –141C Ins/Del. Methods: Subjects included 120 suicide attempters and 123 unrelated volunteers. Those who attempted suicide were severely injured and were transferred to the emergency unit in our university hospital. To determine each genotype, we performed polymerase chain reaction and restriction fragment length polymorphism analyses. Results: We found significant differences in genotypic and allelic frequencies of –141C Ins/Del and TaqIA polymorphisms between suicide attempters and healthy controls (–141C Ins/Del, p = 0.01; TaqIA,p = 0.036). The Ins allele of –141C Ins/Del was significantly more frequent in suicide attempters (p = 0.011), as well as the A2 allele of TaqIA (p = 0.017). Haplotype analysis revealed no significant linkage disequilibrium between –141C Ins/Del and TaqIA polymorphisms (D′ = 0.226, r2 = 0.016, p = 0.10). Conclusions: These findings suggest that DRD2 gene polymorphisms may be involved in the biological susceptibility to suicide.

Trait aggression in suicide attempters: a pilot study.

Suicide attempt is a potent risk factor of subsequent suicide. Understanding the characteristics of suicide attempters is important for preventing suicide. The authors investigated aggression in medically serious suicide attempters at an emergency department. Trait aggression was evaluated in 55 suicide attempters and 71 healthy individuals as a control group using the Japanese version of the Buss‐Perry Aggression Questionnaire (BAQ). Total BAQ scores (t = 2.782, P = 0.006) and the hostility scores (t = 3.735, P < 0.001) were significantly higher in the suicide attempters than the controls. It suggested that to focus on aggression and its management is one of the key components for preventing suicide.

Characteristics of suicide attempters with family history of suicide attempt: a retrospective chart review

BackgroundFamily history of suicide attempt is one of the risks of suicide. We aimed at exploring the characteristics of Japanese suicide attempters with and without a family history of suicide attempt.MethodsSuicide attempters admitted to an urban emergency department from 2003 to 2008 were interviewed by two attending psychiatrists on items concerning family history of suicide attempt and other sociodemographic and clinical information. Subjects were divided into two groups based on the presence or absence of a family history of suicide attempt, and differences between the two groups were subsequently analyzed.ResultsOut of the 469 suicide attempters, 70 (14.9%) had a family history of suicide attempt. A significantly higher rate of suicide motive connected with family relations (odds ratio 2.21, confidence interval 1.18–4.17, p < .05) as well as a significantly higher rate of deliberate self-harm (odds ratio 2.51, confidence interval 1.38–4.57, p < .05) were observed in patients with a family history of suicide compared to those without such history. No significant differences were observed in other items investigated.ConclusionThe present study has revealed the characteristics of suicide attempters with a family history of suicide attempt. Further understanding of the situation of such individuals is expected to lead to better treatment provision and outcomes, and family function might be a suitable focus in their treatment.

Trait impulsivity in suicide attempters: Preliminary study

Suicide attempt is a risk factor for suicide. To investigate trait impulsivity among suicide attempters, 93 attempters admitted to an emergency department and 113 healthy controls were evaluated using the Japanese version of the Barratt Impulsiveness Scale (BIS‐11J). Impulsivity was analyzed in relation to clinical data in the attempters. Total BIS‐11J, attention impulsiveness, and motor impulsiveness scores were significantly higher in the attempters than in the controls. Both total BIS‐11J and non‐planning impulsiveness scores were significantly higher in attempters with schizophrenia and other psychotic disorders among the diagnostic groups. Control of impulsivity should be considered as one of the targets for suicide prevention.

Reliability, validity and clinical utility of a Japanese version of the Social Adaptation Self-evaluation Scale as calibrated using the Beck Depression Inventory

Aim:  The Social Adaptation Self‐evaluation Scale (SASS) was developed to assess the social impairment caused by depression. The purposes of this study were to develop a Japanese version of the SASS (SASS‐J) and to evaluate its reliability and validity.

Comparison of characteristics of suicide attempters with schizophrenia spectrum disorders and those with mood disorders in Japan

Suicidality in patients with schizophrenia is high. To clarify the characteristics of suicidal behavior in patients with schizophrenia, we investigated suicide attempters with schizophrenia spectrum disorders in comparison with patients with mood disorders. One hundred patients with schizophrenia spectrum disorders and 155 patients with mood disorders admitted to an emergency department after a suicide attempt were interviewed in detail on items concerning 1) demographic characteristics, 2) previous suicidal behavior, and 3) index suicidal behavior. Differences between the two groups were subsequently analyzed. Patients with schizophrenia spectrum disorders showed a lower incidence of previous deliberate self-harm, and a higher incidence of a subsequent suicide attempt more than 1 year after the previous suicide attempt as well as a higher lethality of index suicide attempt compared to patients with mood disorders. Furthermore, the most common motive for making a suicide attempt in patients with schizophrenia spectrum disorders was having a mental problem. This study revealed the factors associated with suicide attempts among Japanese patients with schizophrenia spectrum disorders, and the nature of these factors makes it difficult to predict future attempts. This makes clear the importance of continuous long-term follow-up with careful attention to the mental symptoms and psychological burden for such patients.

Follow-up study of suicide attempters who were given crisis intervention during hospital stay: Pilot study

TOLERANCE, DEPENDENCE AND withdrawal symptoms are well-known complications of long-term benzodiazepine (BDZ) use, raising thorny problems in any attempt at their discontinuation. Among the scarce available pharmacological interventions, gradual rather than abrupt discontinuation of BDZ and use of the antiepileptic drug (AED) carbamazepine are the only successfully tested ones for their efficacy. Thus, newer innovatory treatments are clearly desirable. The recent marketing of newer AED, especially of the Selective GABA-Reuptake-Inhibitors, such as tiagabine (TGB) might offer new therapeutic options to this end. However, to the best of our knowledge, no such studies or reports are as yet available. In the following, we report precisely on such a case. This is the case of a 68-year-old female patient with a 15-year history of generalized anxiety disorder (GAD) and BDZ-dependence according to Diagnostic and Statistical Manual of Mental Disorders (text revision) criteria without any other psychiatric comorbidity, or medication. For the last five years, she was clearly abusing the BDZ bromazepam at a dosage of 75 mg/day, moreover with a notable tolerance to this drug, as attested by her high levels of anxiety despite its high dosage. This fact along with her resolution to address her BDZ-dependence motivated her hospitalization at our Department. On admission, the patient scored 39 on the Hamilton Anxiety Rating Scale (HARS). Her extensive medical and laboratory workup yielded no pathological findings. After obtaining the patient’s written informed consent, we incrementally substituted TGB up to 15 mg/day for bromazepam within one week, each day replacing 10 mg of the latter with 2 mg of the former. Dizziness, headache and sedation were the only transient side-effects of TGB, subsiding within 10 days. On discharge, four weeks later, the patient’s scores on the HARS had dropped to 22, a reduction rate by almost 44%. With respect to its mechanism of action, we should note that TGB enhances GABAergic neurotransmission through its blockade of the GABA transporter I (GAT I). Besides its indication in epilepsy, TGB has been found safe and efficacious in various anxiety disorders including GAD, panic disorder, agoraphobia and post-traumatic stress disorder. Moreover, in another recent study TGB has been found efficacious as monotherapy for major depressive disorder with anxiety. However, we should mention the possible temporal delay of TGB – one week – to bring about its anxiolytic effects. Although anecdotic and thus warranting replication in large and wellcontrolled studies, the findings of our case report suggest that TGB might be a promising new pharmacological agent in the treatment of BDZ dependence. REFERENCES

Neuroleptic malignant syndrome induced by perospirone.

Neuroleptic malignant syndrome (NMS) is a rare, but serious and potentially lethal, adverse reaction to neuroleptics characterized by hyperthermia, extrapyramidal symptoms, altered consciousness, and autonomic dysfunction, including diaphoresis, and incontinence. Recent case reports have indicated that atypical antipsychotics can also cause NMS (Ananth et al., 2004). We here report the first case of a patient who developed NMS induced by perospirone, an atypical antipsychotic drug, which has recently been licensed for use in Japan.

Neuroleptic malignant syndrome induced by perospirone the first case report

Results: Wake time after sleep onset and stage 1 duration was markedly increased in the schizophrenia patients compared with the controls. On the other hand, sleep efficiency and stage 4 duration show markedly decreased. Rapid eye movement (REM) latency was found to be moderately decreased, but it was not significant. A single dose of oral risperidone reduced wake time after sleep onset, whereas sleep efficiency and subjective sleep quality were enhanced. Concerning sleep architecture, stage 2 sleep was augmented, whereas slow wave sleep was not affected. REM latency moderately increased (63 versus 99 min), but other REM sleep parameters were only slightly altered.