Ronald Winchel

Suicide and the self-harm continuum: phenomenological and biochemical evidence

The thrust of biological research in psychiatry has generally followed the classic approach which aims at identifying biochemical differences between individuals who make up one diagnostic group and either normal controls or patients from another diagnostic group (e.g. schizophrenia vs. normal controls or schizophrenia vs. depression). The focus of our research, and in more recent years, of others, has been one of identifying specific behaviors common to many diagnostic groups and biochemical events which correlate with them (e.g. suicide). In this report we review the phenomenological and biochemical evidence that suicide, self-mutilation and trichotillomania may represent points along a continuum of self-harm.

Negative and depressive symptoms in suicidal schizophrenics

The aim of this study was to determine the value of positive, negative and depressive symptoms, and of the dexamethasone suppression test (DST), in differentiating schizophrenics with and without a history of suicide. Fifty‐seven hospitalized patients with schizophrenia were assessed at the end of a neuroleptic free interval with the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HRSD), and with a dexamethasone challenge. Suicide attempters were significantly more likely to meet criteria for major depression than nonattempters. Scores on the HRSD differentiated the two groups whereas the sums of positive and negative symptom items from the BPRS did not. DST a.m. and p.m. cortisol values differentiated suicide attempters from nonattempters and HRSD scores correlated significantly with cortisol levels. This study confirms the importance of depressive symptoms in schizophrenic patients with a history of suicide. Assessment of the hypothalamic‐pituitary‐adrenal axis in schizophrenia may also provide useful information.

Antemortem and Postmortem Measures of Central Nervous System Serotonergic Function: Methodological Issues

Recent years have seen the emergence of great interest in the function of the serotonergic neurotransmitter system. Research in this area, however, is complicated by the relative inaccessibility of central measures (i.e., cerebrospinal fluid and brain tissue). Compounding this difficulty is the sensitivity of the serotonergic system to a number of variables. We review here a variety of factors that may influence measures of serotonergic activity and briefly discuss the evidence for their impact on these measures.

Sleep abnormalities, CSF 5-HIAA, depression and suicidality in schizophrenic patients

The purpose of this study is twofold: (1) to examine the association between sleep abnormalities and serotonin function in schizophrenic patients and (2) to determine whether sleep abnormalities in schizophrenic patients are related to depressive and suicidal symptomatology. Sleep abnormalities have been well described among patients with major depression. Although less well researched, similar abnormalities of sleep have also been described among patients with schizophrenia. The presence of depressive symptoms among patients with schizophrenia should be considered as a possible reason for the reported similarity of sleep abnormalities in these two populations. In addition, function of serotonin, which plays a role in sleep onset and sleep architecture, has been demonstrated to be dysregulated among samples of patients with suicidal behavior. Abnormalities of sleep architecture may therefore be associated with suicidal behavior. In the current study indices of serotonergic function (cerebrospinal fluid concentrations of 5Hydroxyindoleacetic acid and platelet 3H-imipramine binding) were measured in drug-free schizophrenic patients have had three night polysomnographic sleep monitoring. Behavioral measures of depression and suicidality were also obtained. Data will be presented regarding associations among sleep indices (such as REM latency and sleep efficiency), serotonergic function and the presence of symptoms of depression and suicidality.