ADVANCES IN CLINICAL SUICIDOLOGY III

DIMENSIONS OF AFFECT AND SERUM LIPIDS IN DEPRESSED SUICIDE ATTEMPTERS Paplos K., Kontaxakis V., Havaki-Kontaxaki B., Ferentinos P., Soldatos C. Eginition Hospital, Department of Psychiatry, University of Athens INTRODUCTION • Research over the past years made apparent, that the suicidal behaviour is the consequence of a complex, and dynamic interaction, between multi-dimensional risk factors. ( Hawton K, van Heeringen K, 2002 ) • In this sense, this study examines the relationship between Depression, dimensions of the affect ( Impulsivity, Anhedonia, Alexithymia ), and Serum Lipid fractions ( HDL-C, LDL-C, TR ) levels in suicide attempters. INTRODUCTION cont. • Cholesterol has been related impulsivity and suicidal behaviour. ( Muldoon 1990, Kaplan 1994 ) to depression, However, the results of studies examining cholesterol, depression and psychological correlates, have been conflicting. • Anhedonia, “the loss of pleasure and interest”, is well recognized as occurring during depressive illness. A few studies have suggested a relationship between anhedonia and suicidal behaviour. (Fawcett 1990, Nordström 1995, Loas 2000 ) • Alexithymia, “no words for mood”, are often associated with depression, but little is known about the associations between alexithymia and suicidal behaviour. (Taiminen 1996, Hintikka 2004) METHOD • SETTING : General Hospital, Athens, Greece. • SUICIDE ATTEMPT DEFINITION : as developed for the WHO in European Study on Parasuicide (Platt et al 1992). • SUBJECTS : 50 depressed (current depressive episode) patients, admitted to Pathology Department following suicide attempt by overdose. • EXCLUSION CRITERIA : - Age <18 or >65 years - Significant weight loss in the month prior to admission - Current infection - Abnormality on haematological, liver, renal function tests - Patients who used lipid-lowering drugs - Eating disorders, Psychotic disorders, and SubstancesRelated disorders METHOD cont. • ASSESSMENTS - Clinical evaluation was performed by two independent psychiatrists. - Patients were diagnosed according to DSM-IV criteria. Rating Scales : - Depression severity: Montgomery-Asberg Depression Rating Scale ( MADRS; Montgomery et al 1979, Snaith et al 1986, Müller et al 2003, 10-item scale, rated 0-6, total score 60, >20= moderate, >31= severe) - Anhedonia: MADRS item 8 ( “inability to feel”, MADRS-8 ) - Impulsivity: Impulsivity Rating Scale ( IRS; Lecrubier et al1995, 7-item scale, rated 0-3, total score 21, >8= impulsive) - Alexithymia: Schalling-Sifneos Personality Scale-Revised ( SSPS-R; Sifneos 1986, 20 true / false items, >10= alexithymia ) METHOD cont. • Blood samples were collected by a trained doctor within 24h of admission (following overnight fast). • Serum lipid concentrations enzymatic methods. were assessed using • All patients gave written consent. • Data were analyzed using the SPSS software (version 8.0) for windows. Pearson correlations were used. RESULTS Gender VARIABLE 68 % F MEAN ± SD Age (years ) MADRS MADRS-8 IRS SSPS-R TSC (mg/dl) HDL-C LDL-C STR 35.0 33.5 4.3 9.3 10.3 ± ± ± ± ± 12.2 5.9 0.9 3.9 3.7 175.1 ± 29.5 47.0 ± 13.1 109.5 ± 23.5 89.4 ± 39.0 RESULTS cont. MADRS MADRS-8 MADRS MADRS-8 ,874** IRS SSPS-R TSC HDL-C LDL-C STR IRS SSPS-R TSC HDL-C LDL-C ,364** ,409** - ,334* - ,406* STR * * Correlation is significant at the .01 level ( 2- tailed ) * Correlation is significant at the .05 level ( 2 – tailed ) COMMENTS • To the best of our knowledge this is the first study to assess correlation between serum lipid profiles, anhedonia, and alexithymia in depressed suicide attempters. • The sample size is small. • There is not control group. • A single measurement of serum cholesterol made at admission. • Further studies are needed to clarify, the trait or state dependent character of biological factors ( cholesterol ) and psychological correlates ( impulsivity, anhedonia, alexithymia ), and their interactions. • The study is undergoing, did includes a control group ( depressed patients who have never made a suicide attempt ), and aims to study the relatioship between biological, psychological and social factors.