Rolf Öhman

Prediction of suicidal behavior from biologic tests

Biochemical studies related with suicidal behavior have mainly dealt with monoaminergic and cortico-steroidal measures. We used some of these measures in a study of 61 suicide attempters who, except for occasional doses of benzodiazepines, had been medication free for a mean of 16 days. The monoamine metabolites 5-hydroxyindoleacetic acid, homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol were measured in lumbar cerebrospinal fluid (CSF). We found that violent suicide attempters (N = 18) had 5-hydroxyindoleacetic acid concentrations below the median of all patients, whereas the concentrations of 3-methoxy-4-hydroxyphenylglycol were mainly above the median. We found no significant differences between violent and nonviolent (N = 43) attempters concerning CSF homovanillic acid, 24-hour urinary norepinephrine-epinephrine and cortisol, activity of monoamine oxidase in platelets, or post-dexamethasone plasma cortisol. Four patients completed suicide, and 3 of them had CSF 5-hydroxyindoleacetic acid concentrations at or below the median. All completed suicides had CSF 3-methoxy-4-hydroxyphenylglycol concentrations above the median. Urinary measures and platelet monoamine oxidase activity of completed suicides were in the higher concentration ranges. Patients who repeated suicidal behavior after the index investigation had low 24-hour urinary cortisol levels more often than those who did not repeat. Because our subgroups of patients are small, we cannot draw any firm conclusions about the value of our CSF and urinary biochemical findings predicting suicidal behavior. However, our CSF findings in violent suicide attempters are similar to those observed in other studies.

HPA-related CSF neuropeptides in suicide attempters.

Corticotropin-releasing hormone (CRH), somatostatin (SOM), delta-sleep-inducing peptide (DSIP), neuropeptide Y (NPY), beta-endorphin (beta-END), and vasopressin (AVP), which are regarded as being involved in the HPA-regulation were investigated in lumbar CSF of 44 suicide attempters. The patients were diagnosed according to the DSM-III-R, and rated with the MADRS. The neuropeptides were compared with the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in CSF and with post-dexamethasone plasma cortisol. We found strong correlations between CRH and the peptides SOM and beta-END. The latter also correlated positively with SOM. There were no differences between men and women. Patients with major depressive disorders had significantly lower SOM, CRH, and DSIP than other patients. Both SOM and beta-END correlated negatively with post dexamethasone plasma cortisol in all patients. We found no significant relationships between neuropeptides and CSF 5-HIAA. Patients who had made previous suicide attempts had significantly lower CRH than those who had not. No other significant associations between neuropeptides and suicidal subgroups of patients appeared, and there was no indication of specific neuropeptide patterns in patients who later completed suicide. Intercorrelations of some neuropeptides and low SOM and DSIP in major depressed patients are findings in line with those by others.

Current trends in the incidence of senile and multi-infarct dementia

SummaryOrganic brain syndromes among the elderly have been studied prospectively in a total population during the 25-year period 1947–1972. The population (2,550 persons) originates from a geographically delimited area in southern Sweden (Lundby). The original population has been followed for 25 years irrespective of domicile. A comparison of incidences for the first 10-year period (1947–1957) and the second 15-year period (1957–1972) shows a decrease in organic brain syndromes in the population concerning multi-infarct as well as senile dementias.ZusammenfassungProspektive Studien über organisch bedingte Hirnsyndrome in hohem Alter wurden an einer Gesamtbevölkerung in einer Periode von 25 Jahren 1947–1972 durchgeführt. Die Bevölkerung (2550 Personen) stammt aus einem geografisch abgegrenzten Gebiet in Südschweden, hier Lundby genannt. Unabhängig vom Wohnsitz wurde die ursprüngliche Bevölkerung über 25 Jahre beobachtet. Ein Vergleich der Inzidenzen zwischen der ersten 10-Jahresspanne (1947–1957) und der zweiten 15-Jahresspanne (1957–1972) zeigt eine Abnahme von organisch bedingten Hirnsyndromen betreffend Multi-infarkt Demenz sowie Senile Demenz in der Bevölkerung.

Pyramidal neuron size in the hippocampus of schizophrenics correlates with total cell count and degree of cell disarray.

Abstract Hippocampal pyramidal neuron size was determined in all Cornu Ammonis subregions – CA1–CA4 – in five chronic schizophrenic men and compared with eight controls matched with respect to age and sex. Four out of five probands and the same eight controls had been examined in a previous study showing a significantly lower cell count and disorientation of pyramidal cells in the CA1– CA3 subregions of the schizophrenics. There was also a negative correlation between the total number of cells and the number of disoriented cells. In this study it was shown that the schizophrenic probands also had significantly smaller neurons in all subregions. There was a significant negative correlation between pyramidal neuron size and the number of disarrayed neurons in each subregion, and there was a significant positive correlation between neuron size and the total number of pyramidal cells in CA1 and CA2, but not in CA3 and CA4. The consistency of hippocampal anomalies in these schizophrenics is, thus, demonstrated by the statistical relations between the different parameters examined.

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.

Senile dementia of the Alzheimer type in the Lundby Study. II. An attempt to identify possible risk factors.

SummaryIn recent years research on senile dementia of the Alzheimer type (SDAT) has made progress within the field of pathology and to a certain extent in that of heredity. Within epidemiology, the search for risk factors is intensifying but the findings are still inconclusive. The present study of possible risk factors concentrates on environmental and personality factors. The total population of 2612 persons from a geographically delimited area, Lundby, two neighbouring parishes in southern Sweden, was examined in 1957 by one psychiatrist (Hagnell). A follow-up study of the same population, irrespective of domicile, was performed 15 years later, in 1972. Various precipitating as well as protective personality background factors were found to be significant for the outcome of SDAT, but no environmental factors appeared to be statistically significant in this cohort.

Peripheral serotonergic markers in patients with suicidal behavior

Peripheral serotonergic parameters were studied in 17 patients with a history of suicidal behavior and in 17 age- and sex-matched healthy controls. Serotonin2 receptor function in platelets, measured as serotonin-induced [32P]phosphatidylinositol 4,5-bisphosphate hydrolysis, was significantly higher in patients than in age- and sex-matched controls. Increased serotonin2 receptor transduction was not correlated to psychiatric diagnosis, drug treatment or a history of violent suicide attempt. Monoamine oxidase activity was lower in platelets from patients with a history of suicidal behavior than in controls. In addition, whole blood serotonin was analyzed but no significant alterations were found in blood from patients.

Senile dementia of the Alzheimer type in the Lundby Study. I. A prospective, epidemiological study of incidence and risk during the 15 years 1957-1972.

SummaryIn spite of the great impact of senile dementia of the Alzheimer type (SDAT) on society, far too little is known about its epidemiology. In this study of a total, normal population from a geographically delimited area in Sweden, Lundby, 2612 persons were examined in 1957 by one psychiatrist (Hagnell). In 1972 the same population was reexamined irrespective of domicile. The incidence and risk of contracting SDAT during the 15 years were calculated. No cases of SDAT were diagnosed before the age of 60 years. The lifetime risk was for men 25.7% and for women 26.2%. When only the very severely impaired were taken into account, the figures were 14.5% in men and 14.6% in women.

Epidemiology of cycloid psychosis

SummaryThe objective of the present study on cycloid psychosis was to describe the incidence and risk in a defined population sample. We therefore re-evaluated specific diagnostic groups in the 1947 cohort of the Lundby Study. Three female cases were identified as cycloid psychosis according to the diagnostic criteria of Leonhard, Perris and Brockington. No men were found. The incidence rate (per 100 observation years) was found to be 0.016% for women. The cumulative probability i.e. risk, up to 60 years of age was calculated to be 0.7%. Incidence rate and risk for cycloid psychosis in women was thus about half of the corresponding values for schizophrenia as described for the same population in a parallel study. We conclude that cases of cycloid psychosis constitute a substantial proportion of female psychotic patients.

Incidence of cycloid psychosis : a clinical study of first-admission psychotic patients

SummaryThe concept of cycloid psychosis has gained increasing acceptance during recent decades. Using the diagnostic criteria of Perris and Brockington, an intelligible delineation of a group of patients has been obtained. Few epidemiological data on cycloid psychosis have been reported so far. The objective of the present study was to describe the one-year incidence of cycloid psychosis in a clinical sample. The diagnostic registers of all patients hospitalized for a functional or an organic psychosis and discharged in the year 1983, in Lund, Sweden were investigated. 514 patients were identified of whom 83 were admitted to hospital for the first time. 29 of these patients had a functional psychosis and were below the age of 50. In this age group 7 cases (4 women, 3 men) fulfilled the diagnostic criteria of cycloid psychosis and thus constituted almost one fourth of all first admissions of functional psychoses that year. The one-year incidence for first admission in cycloid psychosis was 5.0 per 100000 inhabitants in women and 3.6 per 100000 inhabitants in men within the age group 15–50 years in the catchment area of 163 175 persons. We conclude that cycloid psychosis consitutes a considerable proportion of functional psychoses in both sexes.