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Pharmacopsychiatry 2002; 35(2): 44-49
DOI: 10.1055/s-2002-25030
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Concretism in Biological Suicide Research - Are We Eating the Menu Instead of the Meal?

Some Thoughts on Present Research StrategiesB.  Müller-Oerlinghausen, J.  Roggenbach
  • 1Former Clinical Psychopharmacology Research Group, Department of Psychiatry,
    Freie Universität Berlin, Germany
Supported by German Research Network on Depression
Further Information

Publication History

12. 4. 2001

5. 11. 2001

Publication Date:
12 April 2002 (online)

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Research into serotonergic parameters associated with suicidal behaviour has resulted in many inconsistent and ambiguous findings. In this mini-review, we have tried to name some examples of methodological and conceptual vagueness and pitfalls in biological suicide research. The existing literature indicates various critical issues considered when interpreting existing data in this area:

  • The ‘suicidality’ construct is not useful in biological suicide research. Autodestructive tendencies mostly occur in suicide completers and are probably not found in many suicide attempters and individuals with suicidal thoughts. No consistent association has been found between suicide intent and injury, suicide intent and suicide risk, choice of suicide method (violent vs. non-violent) and suicide risk, suicidal thoughts or attempted suicide. No close relationship between different degrees and different forms of suicidal behaviour has yet been demonstrated with any degree of consistency. According to many studies, serotonergic markers do not correlate with the various qualities and intensities of suicidal behaviour.

  • The association between suicidality and impulsivity or aggression is weak. There probably is a disturbance in impulse and aggression control, but only in a subgroup of ‘suicidal’ patients.

  • It might be misleading to use nosological constructs of depression in order to characterize suicidal individuals in biological suicide research. Biological variables might be associated with specific depressive symptoms, but not with some nosological construct or the sum score of a depression rating scale.

  • The alleged association between peripheral and central serotonergic parameters is based on assumptions for which there is insufficient proof. Several studies indicate that there is no correlation between changes in central and peripheral serotonergic parameters. The mechanism of changes of peripheral serotonergic parameters is not sufficiently understood.

References

  • 1 Andres A, Rao M L, Ostrowitzki S, Entzian W. Human brain cortex and platelet serotonin2 receptor binding properties and their regulation by endogenous serotonin.  Life Sciences. 1992;  52 313-321
    PubMedGoogle Scholar
  • 2 Apter A, van Praag H M, Plutchik R, Sevy S, Korn M, Brown S L. Interrelationships among anxiety, aggression, impulsivity, and mood: A serotonergically linked cluster?.  Psychiatry Research. 1990;  32 191-199
    CrossrefPubMedGoogle Scholar
  • 3 Apter A, Plutchik R, van Praag H M. Anxiety, impulsivity and depressed mood in relation to suicidal and violent behavior.  Acta Psychiatrica Scandinavica. 1993;  87 1-5
    PubMedGoogle Scholar
  • 4 Asberg M, Träskmann L, Thoren P. 5-HIAA in cereobrospinal fluid. A biochemical suicide predictor?.  Arch Gen Psychiatry. 1976;  33 1193-1197
    Google Scholar
  • 5 Asberg M. Neurotransmitters and suicidal behavior.  Ann of N.Y. Academy of Sciences. 1997;  836 158-181
    PubMedGoogle Scholar
  • 6 Biegon A, Grinspoon A, Blumenfeld B, Bleich A, Apter A, Mester R. Increased serotonin 5HT2 receptor binding on blood platelets of suicidal men.  Psycho-pharmcology. 1990a;  100 165-167
    PubMedGoogle Scholar
  • 7 Brown G L, Ebert M H, Goyer P F, Jimerson D C, Klein W J, Bunney W E, Goodwin F K. Aggression, suicide, and serotonin: Relationships to CSF amine metabolites.  American Journal of Psychiatry. 1982;  139/6 741-746
    PubMedGoogle Scholar
  • 8 Camacho A, Dimsdale J E. Platelets and psychiatry: Lessons learned from old and new studies.  Psychosomatic Medicine. 2000;  62 326-336
    PubMedGoogle Scholar
  • 9 Coccaro E F, Siever L J, Klar H M, Maurer G, Cochrane K, Cooper T B, Mohs R C, Davis K L. Serotonergic studies in patients with affective and personality disorders.  Archives of General Psychiatry. 1989a;  46 587-599
    PubMedGoogle Scholar
  • 10 Corruble E, Damy C, Guelfi J D. Impulsivity: a relevant dimension in depression regarding suicide attempts.  Journal of Affective Disorders. 199;  53 211-215
    PubMedGoogle Scholar
  • 11 Diekstra R FW. Suicidal behavior and depressive disorders in adolescents and young adults.  Neuropsychobiology. 1989;  22 194-207
    PubMedGoogle Scholar
  • 12 Diekstra R FW. The epidemiology of suicide and parasuicide.  Acta Psychiatr Scand. 1993;  371 (suppl.) 9-20
    PubMedGoogle Scholar
  • 13 Dilling H, Reimer C. Psychiatrie und Psychotherapie. Dilling H, editor Berlin Heidelberg; Springer-Verlag 1995
    Google Scholar
  • 14 Duckworth G, McBride H. Suicide in old age: A tragedy of neglect.  Can J Psychiatry. 1996;  41 217-222
    PubMedGoogle Scholar
  • 15 Elliot J M. Platelet receptor binding studies in affective disorders.  Journal of Affective Disorders. 1984;  6 219-239
    CrossrefPubMedGoogle Scholar
  • 16 Felber W. Typologie des Parasuizids. In: Pohlmeier H, editor Regensburg; S. Roderer Verlag 1993
    Google Scholar
  • 17 Franke L, Schewe H J, Schley J, Kitzrow W, Müller B, Uebelhack R, Thies-Flechtner K, Müller-Oerlinghausen B. Tryptophanverfügbarkeit und thrombozytäre 5HT-Konzentration bei Patienten mit affektiven Störungen. In: Möller HJ, Müller-Spahn F, Kurtz G, editors Aktuelle Perspektiven der biologischen Psychiatrie. Wien New York; Springer Verlag 1996: 147-150
    Google Scholar
  • 18 Golden R N, Gilmore J H, Corrigan M H, Ekstrom R D, Knight B, Garbutt J. Serotonin, suicide and aggression: Clinical studies.  J Clin Psychiatry. 1991;  52/12 61-69
    PubMedGoogle Scholar
  • 19 Hengeveld M W. Serotonin in attempted suicide.  Journal of Psychosomatic Research.. 1994;  38/7 639-641
    PubMedGoogle Scholar
  • 20 Karege F, Widmer J, Bovier P, Gaillard J M. Platelet serotonin and plasma tryptophan in depressed patients: effect of drug treatment and clinical outcome.  Neropsychopharmacology. 1994;  10/3 207-214
    PubMedGoogle Scholar
  • 21 Klerman G L. Clinical epidemology of suicide.  Journal of Clinical Psychiatry. 1987;  48: (12 [suppl]) 33-38
    PubMedGoogle Scholar
  • 22 Korn M L, Plutchik R, van Praag H M. Panic-associated suicidal and aggressive ideation and behavior.  Journal of Psychiatry Research. 1997;  31 481-487
    CrossrefPubMedGoogle Scholar
  • 23 Kotler M, Finkelstein G, Molcho A, Botsis A J, Plutchik R, Brown S L, van Praag H M. Correlates of suicide and violence risk in an inpatient population: Coping styles and social support.  Psychiatry Research. 1993;  47 281-290
    CrossrefPubMedGoogle Scholar
  • 24 Lesch K P, Gross J, Franzek E, Wolozin B, Riederer P, Murphy D L. Primary structure of the serotonin transporter in unipolar depression and bipolar disorder.  Biol Psychiatry. 1995;  37 215-223
    CrossrefPubMedGoogle Scholar
  • 25 Lester D. The impact of availability, attraction and lethality of suicide methods on suicide rates in Germany.  Acta Psychiatrica Scandinavica. 1995;  92 318
    PubMedGoogle Scholar
  • 26 Leysen J E, Pauwels P J. 5HT2 receptors, roles and regulation. Ann. of N.Y.  Academy of Sciences. 1990;  600 183-194
    PubMedGoogle Scholar
  • 27 Linehan M M. Suicidal people. One population or two?.  Ann of N.Y. Academy of Sciences. 1986;  487 16-33
    PubMedGoogle Scholar
  • 28 Maier W. Genetik suizidalen Verhaltens. In: Wolfersdorf M, Kaschka WP, editors Suizidalität - Die Biologische Dimension. Berlin Heidelberg; Springer-Verlag 1996: 85-95
    Google Scholar
  • 29 Malone K M, Corbitt E M, Li S, Mann J J. Prolactin response to fenfluramine and suicide attempt lethality in major depression.  British Journal of Psychiatry. 1996;  168 324-329
    PubMedGoogle Scholar
  • 30 Mann J J. Psychobiologic predictors of suicide.  Journal of Clinical Psychiatry. 1987;  48/12 39-43
    PubMedGoogle Scholar
  • 31 Mann J J, Arango V. Integration of neurobiology and psychopathology in a unified model of suicidal behavior.  Journal of Clinical Psychopharmacology. 1992;  12/2 2S-7S
    PubMedGoogle Scholar
  • 32 Mann J J, McBride P A, Anderson G M, Mieczkowski T A. Platelet ad whole blood serotonin content in depressed inpatients: correlations with acute and life-time psychopathology.  Biological Psychiatry. 1992a ;  32 243-257
    CrossrefPubMedGoogle Scholar
  • 33 Mann J J, McBride A, Brown R P, Linnoila M, Leon A C, DeMeo M, Mieczkowski T, Myers J E, Stanley M. Relationship between central and peripheral serotonin indexes in depressed and suicidal psychiatrc inpatients.  Archives of General Psychiatry. 1992b ;  49 442-446
    PubMedGoogle Scholar
  • 34 Mann J J, Malone K M. Cerebrospinal fluid Amines and higher-lethality suicide attempts in depressed inpatients.  Biological Psychiatry. 1997;  41 162-171
    CrossrefPubMedGoogle Scholar
  • 35 Markowitz P I, Coccaro E F. Biological studies of impulsivity, aggression, and suicidal behavior. In: Hollander E, Stein, editors Impulsivity and Aggression. Chichester New York Brisbane Toronto Singapore; John Wiley & Sons 1995: 71-90
    Google Scholar
  • 36 McBride A P, Brown R P, DeMeo M, Keilp J, Mieczkowski T, Mann J J. The relationship of platelet 5HT2 receptor indices to major depressive disorder, personality traits, and suicidal behavior.  Biological Psychiatry. 1994;  35 295-308
    CrossrefPubMedGoogle Scholar
  • 37 McClure G MG. Changes in suicide in England and Wales, 1960 - 1997.  British Journal of Psychiatry. 2000;  176 64-67
    CrossrefPubMedGoogle Scholar
  • 38 Meltzer H, Arora A. Platelet markers of suicidality. Ann.  of N.Y. Academy of Sciences. 1986;  487 271-280
    PubMedGoogle Scholar
  • 39 Montgomery S A, Montgomery D. Pharmacological prevention of suicidal behavior.  Journal of Affective Disorders. 1982;  4 291-298
    CrossrefPubMedGoogle Scholar
  • 40 Moret C, Briley M. Platelet 3H-paroxetine binding to the serotonin transporter is insensitive to changes in central serotonergic innervation in the rat.  Psychiatry Research. 1991;  38 97-104
    CrossrefPubMedGoogle Scholar
  • 41 Mühlbauer H D. Human aggression and the role of central serotonin.  Pharmacopsychiatry. 1985;  18 218-221
    PubMedGoogle Scholar
  • 42 Murphy D. Peripheral indices of central serotonin function in humans. Ann.  of N.Y. Academy of Sciences.. 1990;  600 282-291
    PubMedGoogle Scholar
  • 43 Pandey G N, Pandey S C, Dwivedi Y, Sharma R, Janicak P G, Davis J M. Platelet Serotonin-2A receptors: A potential marker for suicidal behavior.  American Journal of Psychiatry. 1995;  152/6 850-855
    PubMedGoogle Scholar
  • 44 Plutchik R, van Praag H M, Picard S, Conte H R, Korn M. Is there a relation between the seriousness of suicidal intent and the lethality of suicide attempt?.  Psychiatry Research. 1989a;  27 71-79
    CrossrefPubMedGoogle Scholar
  • 45 Plutchik R, van Praag H M, Conte H R. Correlates of suicide and violence risk: III. A two stage model of countervailing forces.  Psychiatry Research. 1989b;  28 215-225
    CrossrefPubMedGoogle Scholar
  • 46 Plutchik R. Outward and inward directed aggressiveness: the interaction between violence and suicidality.  Pharmacopsychiatry. 1995;  28 47-57
    PubMedGoogle Scholar
  • 47 Plutchik R, van Praag H M. The nature of impulsivity: Definitions, ontology, genetics, ad relations to aggression. In: Hollander E, Stein, editors Impulsivity and Aggression. Chichester New York Brisbane Toronto Singapore; John Wiley & Sons 1995: 7-24
    Google Scholar
  • 48 Rao M L, Hawellek B, Papassotiropoulos A, Deister A, Frahnert C. Upregulation of the platelet serotonin2A receptor and low blood serotonin in suicidal psychiatric patients.  Neuropsychobiology. 1998;  38 84-89
    CrossrefPubMedGoogle Scholar
  • 49 Reimer C, Arentewicz G. Kurzpsychotherapie nach Suizidversuch. In Reimer C, editor Berlin Heidelberg New York London Paris Tokyo Hongkong Barcelona Budapest; Springer-Verlag 1993
  • 50 Roy A, Ninan P, Mazonson A, Pickar D, van Kammen D, Linnoila M, Paul S M. CSF monoamine metabolites in chronic schizophrenic patients who attempt suicide.  Psychological Medicine. 1985;  15 335-340
    PubMedGoogle Scholar
  • 51 Roy A, Lamparski D, DeJong J, Adinoff B, Ravitz B, George D T, Nutt D, Linnoila M. Cerebrospinal fluid monoamine metabolites in alcoholic patients who attempt suicide.  Acta Psychiatrica Scandinavica. 1990;  81 58-61
    PubMedGoogle Scholar
  • 52 Roy A, Rylander G, Sarchiapone M. Genetics of suicide.  Ann of N.Y. Academy of Sciences. 1997;  836 135-157
    PubMedGoogle Scholar
  • 53 Roy-Byrne P, Post R M, Rubinow D R, Linnoila M, Savard R, Davis D. CSF 5HIAA and personal and family history of suicide in affectively ill patients: A negative study.  Psychiatry Research. 1983;  10 263-274
    CrossrefPubMedGoogle Scholar
  • 54 Sarrias M J, Martinez E, Celada P, Udina C, Alvarez E, Artigas F. Plasma free 5HT in depression: Case control studies and the effect of antidepressant therapy. In: Schwarcz et al., editors Kynenurenine and Serotonin Pathways. New York; Plenum Press 1991: 653-658
    Google Scholar
  • 55 Stahl S M. Platelets as pharmacological models for the receptors and biochemistry of monoaminergic neurons. In Longenecker, editor The platelets: Physiology and pharmacology. 1985: 307-340
    Google Scholar
  • 56 Theodorou A E, Katona C LE, Davies S L, Hale A S, Kerry S M, Horton R W, Kelly J S, Paykel E S. 3H-imipramine binding to freshly prepared platelet membranes in depression.  Psychiatry Research. 1989;  29 87-103
    CrossrefPubMedGoogle Scholar
  • 57 Träskman L, Asberg M, Bertilsson L, Sjöstrand L. Monoamine Metabolites in CSF and suicidal behavior.  Archives of General Psychiatry. 1982;  38 631-636
    PubMedGoogle Scholar
  • 58 Träskman-Bendz L, Alling C, Oreland L, Regnell G, Vinge E, Öhman R. Prediction of suicidal behavior from biologic tests.  Journal of Clinical Psychopharmacology. 1992;  12/2 21S-26S
    PubMedGoogle Scholar
  • 59 van Praag H M, Asnis G M, Kahn R S, Brown S L, Korn M, Harkavy Friedmann JM, Wetzler S. Nosological tunnel vision in biological psychiatry.  Ann of N.Y. Academy of Sciences. 1990;  600 501-508
    PubMedGoogle Scholar
  • 60 van Praag H M. Serotonergic dysfunction ad aggression control. In: Möller HJ, van Praag HM, editors Aggression und Autoaggression. Berlin Heidelberg; Springer-Verlag 1992: 1-9
    Google Scholar
  • 61 van Praag H M. Serotonin-related, anxiety/aggression-driven, stressor precipitated depression. A psycho-biological hypothesis.  European Psychiatry. 1996a;  11 57-67
    CrossrefPubMedGoogle Scholar
  • 62 van Praag H M, Plutchik R, Conte H. The serotonin hypothesis of (auto)aggression. Critical appraisal of the evidence.  Ann of N.Y. Academy of Sciences. 1997a;  836 150-167
    PubMedGoogle Scholar
  • 63 Verkes R J, van der Mast R C, Kerkhof J FM, Fekkes D, Hengeveld M W, Tuyl J P, van Kempen G MJ. Platelet serotonin, monoamine oxidas activity, and [3H] paroxetine binding related to impulsive suicide attempts and borderline personality disorder.  Biological Psychiatry. 1998a;  43 740-746
    CrossrefPubMedGoogle Scholar
  • 64 Weissman M, Fox K, Klerman G L. Hostility and depression associated with suicide attempts.  American Journal of Psychiatry. 1973;  140/4 450-455
    PubMedGoogle Scholar
  • 65 Wiedenmann A, Weyerer S. The impact of availability, attraction and lethality of suicide methods on suicide rates in Germany.  Acta Psychiatrica Scandinavica. 1993;  88 364-368
    PubMedGoogle Scholar
  • 66 Young W F, Laws E R, Sharbrough F W, Weinshilboum R M. Human monoamine oxidase - lack of brain and platelet correlation.  Archives of General Psychiatry. 1986;  43 604-609
    PubMedGoogle Scholar

Univ.-Prof. Dr. med. B. Müller-Oerlinghausen

Jebensstr. 3

10623 Berlin

Phone: +49 (30) 310 01-361

Fax: +49 (30) 310 01-366

Email: bmoe@zedat.fu-berlin.de

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