Margot Alsén

Hopelessness and suicidal behavior

The main purpose of this study was to investigate the relationship of the Beck Hopelessness Scale (BHS) with suicidal behavior and other clinical variables in 212 hospitalized suicide attempters. Another purpose was to analyze the usefulness of BHS in this particular context. Those who later committed suicide (N = 13) had significantly higher median scores than those who did not. Even though the median BHS score for the total population was above the cut-off score for future suicide risk, suggested by Beck et al., the relative ratio of correctly positive/false positive was low. Therefore the BHS does not seem to be a satisfactory instrument for predicting future suicide in hospitalized suicide attempters. Our findings rather suggest that the BHS is related to depression ratings, mood disorders and/or personality disorders.

High Suicidal Intent Scores Indicate Future Suicide

The aim of this study was to scrutinize individual items as well as total scores of the Suicidal Intent Scale (SIS) in order to find out its usefulness for predicting suicide. Consecutive patients (N=555) were evaluated and rated with SIS shortly after a suicide attempt. When followed up at a mean time of 4.5 years, 22 (4%) had committed suicide. Those who later committed suicide had been scored significantly higher than those who did not commit suicide. In an effort to find a score-limit of the SIS which could be associated with future suicide, we formulated a receiver operating characteristic curve. From this we were able to detect a sensitivity of 90% and a specificity of 60.3% of scores of 19 and above in people aged 55 years and older. In a logistic regression analysis we also found that age above 55 years, mood disorder diagnoses and SIS scores of 19 or above significantly predicted suicide. Our conclusion is that the SIS could be a valuable tool in predicting suicide, especially in elderly suicide attempters.

The Suicide Assessment Scale: an instrument assessing suicide risk of suicide attempters

The Suicide Assessment Scale (SUAS), a scale constructed to measure suicidality over time, was administered to 191 suicide attempters. Its predictive validity was tested. SUAS ratings were compared to ratings from other scales, and related to age and psychiatric diagnoses including co-morbidity. Eight patients committed suicide within 12 months after the SUAS assessment. Apart from advanced age, high scores in the SUAS were significant predictors of suicide. From a receiver operating characteristic (ROC) analysis, we identified cutoff SUAS scores which alone and in combination with certain diagnostic and demographic factors are of apparent value in the clinical evaluation of suicide risk after a suicide attempt.

Medicine self-poisoning and the sources of the drugs in Lund, Sweden

The purpose of this study was to investigate the prevalence of toxic agents in attempted and completed suicides. The purpose was also to explore the sources of the drugs taken by suicide attempters. Verbal information on drug intake was collected from 280 suicide attempters during 1987–1990 in the Lund‐Orup catchment area. Information on the sources of the drugs was collected from 143 of these attempters. The study also includes toxicological screening from 73 fatal poisonings in southern Sweden during 1989. According to verbal information, the most common drugs used by suicide attempters were benzodiazepines (51%), analgesics (29%) and antidepressants (20%). In suicide attempters, diazepam and levomepromazine were reported more than expected from prescription data. Toxicological screenings of fatal poisonings showed that benzodiazepines were most common (55%), followed by analgesics (38%), mainly propoxyphene (29%) and antidepressants (30%), mainly amitriptyline (22%). Amitriptyline and diazepam were more commonly detected in completed suicides than expected from prescription data. The most common sources of drugs to attempted suicides were physicians, and especially psychiatrists. We therefore conclude that continuous information to physicians on drug overdose is important, and it is also important to introduce alternative strategies to prevent suicidal behaviour.

The role of monoamines in suicidal behavior

Cerebrospinal fluid (CSF), urine, platelet and neuroendochrine challenge tests of monoaminergic function give evidence of monoamines, especially serotonin, playing an important role in suicidal behavior. However, additional clinical, social and biochemical factors are necessary to better define suicide‐prone psychiatric patients.

CLASSIFICATION OF SUICIDE ATTEMPTERS BY CLUSTER ANALYSIS : A STUDY OF THE TEMPERAMENTAL HETEROGENEITY IN SUICIDAL PATIENTS

Abstract As several studies have associated various temperament dimensions with suicidality when comparing suicide attempters with non-attempters, the purpose of the present study was to focus on the temperamental heterogeneity, and to identify sub-groups of suicide attempters with specific temperament profiles. The Karolinska Scales of Personality (KSP) and the Eysenck Personality Questionnaire together with the IVE-Impulsiveness scale (EPQ-I) were administered in a sample of 215 attempters aged 18–81 years, and cluster analysis procedures were performed with the KSP scales as clustering variables. The subjects were allocated into six mutually exclusive clusters with different temperament profiles. The EPQ-I was used in the attempts to validate and to further describe the cluster solution. Most of the clusters showed low Socialization scores and high scores on scales measuring trait Anxiety. We identified a sub-group with an extreme temperament profile scoring high on scales measuring trait Anxiety, Impulsiveness, Aggressivity, and on scales related to Psychoticism. We also identified an introverted and detached sub-group with high scores on Detachment (low Extraversion) and high trait Anxiety. A large sub-group showed no personality pathology in the sense that they had normal scores on all scales. Our results clearly indicate that suicide attempters are temperamentally heterogenous group, and that there are several different suicidal personalities. The temperamental heterogeneity of clinical importance and is worth further study.

Self-poisonings with drugs by adolescents in the Lund catchment area

Our objective was to investigate which drugs young people who attempt suicide use in the Lund catchment area eight municipalities in Skåne, southern Sweden. All patients aged up to 18 years admitted to Lund University Hospital after deliberate or probably deliberate self-poisoning from 1 January 1991 until 31 December 1995 were included. Forty-nine (58%) had used a single drug; 20 (24%) had used 3 or more drugs. Fifty-two (61%) used analgesics paracetamol was used by 38 (45%) and propoxyphene by 17 (20%). Thirty-one (36%) had ingested psychotropics 13 used benzodiazepines, 10 antidepressants, and 8 antipsychotics. Eleven (15%) had used drugs in combination with alcohol. We conclude that it is important to follow changes in self-poisoning patterns, to monitor the effects of preventive work and discover new trends in drug use.

Changes of cerebrospinal fluid monoamine metabolites during long-term antidepressant treatment

This study describes the changes in cerebrospinal fluid (CSF) monoamine metabolites during antidepressant treatment for more than 6 months. Eight patients, who received antidepressant treatment after attempted suicide and then underwent lumbar punctures every 3 or 4 months, were included. Plasma drug concentrations and the clinical outcome were also measured. Consistent with previous reports about antidepressant treatment for between 3 and 6 weeks, both 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) and 5-hydroxyindoleacetic acid (5-HIAA) were significantly decreased after treatment for a mean of 15 weeks compared to pretreatment. However, after continued treatment for a mean of 30 weeks the MHPG concentration remained significantly lower than at pretreatment while 5-HIAA had returned to the pretreatment level. The clinical outcome was significantly correlated to the pretreatment 5-HIAA/MHPG ratio. These results suggest that the frequently reported reduction in CSF 5-HIAA after antidepressant treatment does not remain during long-term treatment.

Use of antidepressants in deliberate self-poisoning: psychiatric diagnoses and drugs used between 1987 and 1997 in Lund, Sweden.

Abstract.Objective:Based on the increased prescription of antidepressants, the aim of this study was to analyse the changes in self-poisonings with antidepressants during the period 1987–1997.Methods:A total of 909 patients who were admitted to hospital after deliberate self-poisoning were investigated regarding psychiatric diagnoses and drugs ingested.Results:In the whole group, there was no significant change in the rate of antidepressant overdoses between 1987 and 1990 (20%) and 1995 and 1997 (17 %), but among females with a mood disorder overdoses decreased from 43% to 22% (p = 0.01). The proportion of selective serotonin reuptake inhibitors (SSRIs) in self-poisonings was significantly lower than expected from sales figures.Conclusion:The increased antidepressant sales have not caused an increased use of antidepressants in self-poisonings. It is, therefore, tempting to assume that an increased use of antidepressants for appropriate indications causes decreased self-poisoning rates.

Have Biological Studies of Survivors of Suicide Attempts Influenced Our Management

Patients with mood disorders have long been known to have monoaminergic dysregulation (Schildkraut, 1965; Lapin & Oxenkrug, 1969; Siever & Davis 1985; Harro & Oreland 1996; Van Praag, 1996). The heterogeneity of depressive disorders has recently been discussed by Halbreich and Lumley (1993). It is essential to note that a large part of people have depressed mood associated with social dysfunction and suicidality without fulfilling criteria of mood disorders according to conventional systems of classification. The current neurochemical theories of biological correlates of suicidal behaviour principally involve the serotonergic system. The finding of an association between serotonin disturbance and suicidality is very robust and has opened up the possibility for a search for other biological variables that may also be related to suicidal behaviour as such (rather than to any particular psychiatric diagnostic category). Among such variables may be mentioned catecholamines, cortisol and some other hormones, as well as several neuropeptides. Few data are avialable about the role of catecholamines. Monoamines have neuromodulating effects on the endocrine axes, such as the hypothalamus-pituitary-adrenal (HPA) axis, and a dysfunction may be reflected through abnormal secretion of steroids as an effect of stressors (Dinan, 1996).