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Peng R, Zhang X, Li R, Zhang G, Yue Y, Wu S, Wu Y, Yang R, Zhou Y, Du X, Zhang X. Prevalence and clinical correlates of psychotic symptoms in first-episode untreated female chinese patients with major depressive disorder. BMC Psychiatry 2023; 23:549. [PMID: 37507684 PMCID: PMC10385887 DOI: 10.1186/s12888-023-05011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Recent studies have reported that psychotic symptoms are common in patients with major depressive disorder (MDD). However, few studies have reported the relationship between thyroid function, lipid metabolism and clinical profiles in female MDD patients. Thus, this study aimed to investigate the prevalence of psychotic depression (PD) and its risk factors in first-episode and drug naive (FEDN) depression among the female population in China. METHODS This was a cross-sectional study involving a representative probability sample of 1,130 FEDN female outpatients with MDD (aged 18 years or older) in China. We collected information relating to socio-demographic characteristics, clinical data and blood samples. The Hamilton Depression Rating Scale 17-item version (HAMD-17), Hamilton Anxiety Rating Scale 14-item version (HAMA-14), and Positive and Negative Syndrome Scale (PANSS) were used to evaluate depressive, anxiety, and psychotic symptoms. RESULTS The prevalence of psychotic symptoms in female MDD patients was 10.97%. The findings revealed significant differences between MDD female patients with psychotic symptoms and non-PD female patients in the following areas: higher HAMD scores, higher HAMA scores, more severe anxiety and an increased risk of suicide attempts. Further logistic regression analysis showed that psychotic symptoms were associated with higher thyroid-stimulating hormone (TSH) levels and an odds ratio of 1.168. CONCLUSIONS Our findings supported the hypothesis that higher TSH levels were correlated with psychotic symptoms in female MDD patients. Therefore, serum TSH levels may be a potential biomarker of PD in female MDD patients. In addition, we found that PD was closely associated with suicide attempts and lipid levels, but did not reach statistical significance.
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Affiliation(s)
- Ruijie Peng
- Medical College of Soochow University, Suzhou, China
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Xiaobin Zhang
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Ronghua Li
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Guangya Zhang
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Yan Yue
- Medical College of Soochow University, Suzhou, China
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Siqi Wu
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
- School Psychology and Mental Health, North China University of Science and Technology, Qinhuangdao, China
| | - Yuxuan Wu
- Medical College of Soochow University, Suzhou, China
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Ruchang Yang
- Medical College of Soochow University, Suzhou, China
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
| | - Yue Zhou
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China
- Xuzhou Medical University, Xuzhou, China
| | - Xiangdong Du
- Institution of Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, 215131, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoying District, Beijing, 100101, China.
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Sen P, Adewusi D, Blakemore AI, Kumari V. How do lipids influence risk of violence, self-harm and suicidality in people with psychosis? A systematic review. Aust N Z J Psychiatry 2022; 56:451-488. [PMID: 34240626 PMCID: PMC9036157 DOI: 10.1177/00048674211025608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Low cholesterol has been linked with violent and suicidal behaviour in people with schizophrenia. This association, if consistently present, may be a promising biological marker that could assist clinicians in decision making regarding risk and treatment. We conducted a systematic review to assess whether there is a reliable association between lipid profile (total cholesterol, high- and low-density lipoprotein cholesterol, and triglycerides) and aggression, self-harm or suicide in people with schizophrenia, and whether effects are similar in males and females. METHOD Relevant databases were searched to identify primary research studies (up to November 2020) that (1) involved adults (some samples also included 16- to 18-year olds) with a confirmed diagnosis of schizophrenia, schizoaffective disorder or psychosis; and (2) included a standardised assessment of verbal aggression, physical aggression against objects, physical aggression against self (including suicide) or others. The search yielded 23 studies eligible for inclusion following a quality appraisal. RESULTS Suicidality was the most commonly assessed subtype of aggression (20 studies). For suicidality, about half the studies, including the study with the largest sample size, found a link with total cholesterol. An association between low total cholesterol and violence towards others was found in six of nine studies that investigated this. The evidence for a link with violence was the strongest for total cholesterol, followed by low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, and the weakest for triglycerides. Only a few studies investigated sex differences and yielded mixed evidence. Studies focussed on self-harm as well as involving females in forensic settings were lacking. CONCLUSION There is encouraging evidence of an association between low total cholesterol and aggression towards others as well as suicidality in schizophrenia. Future studies should systematically explore this association in people with schizophrenia who have a significant history of violence, suicidality and self-harm, both inpatients and community, and also investigate underlying mechanisms.
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Affiliation(s)
- Piyal Sen
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Danielle Adewusi
- GKT School of Medicine, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Alexandra I Blakemore
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Veena Kumari
- Department of Life Sciences, Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK,Veena Kumari, Department of Life Sciences, and Centre for Cognitive Neuroscience, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK.
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Sankaranarayanan A, Pratt R, Anoop A, Smith A, Espinoza D, Ramachandran P, Tirupati S. Serum lipids and suicidal risk among patients with schizophrenia spectrum disorders: Systematic review and meta-analysis. Acta Psychiatr Scand 2021; 144:125-152. [PMID: 33834474 DOI: 10.1111/acps.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A systematic review of literature was conducted to determine the association between serum lipids and suicidality in people with schizophrenia spectrum disorders. METHODS We undertook a systematic search of multiple databases for studies that ascertained an association between serum lipids and suicidality in adult patients with schizophrenia spectrum disorders (18-65 years) from database inception to 2 September 2020. Qualitative analysis was done using National Institute of Health (NIH) scales. The standard mean difference (SMD) and 95% confidence intervals (CI) were calculated for each study and standardized relative to the study. Adjusted p-value, Z-test, and heterogeneity were calculated, as well as testing for publication bias. RESULTS Of 1262 records identified, 17 studies (n = 3113) were included in our systematic review, while 11 studies were included in the meta-analysis. The majority of studies (11) rated fair on qualitative analysis. Data from seven studies (n = 1597) revealed a medium effect size for an association between low total cholesterol and suicide attempts (SMD -0.560; 95% CI: 0.949-0.170; p = 0.005). People with history of suicide attempt had a mean cholesterol value 0.56 SD lower than the mean in those without suicide attempts. There were differences in how a suicide attempt was defined and there was high heterogeneity (I2 = 83.3%). No significant association was found between any of the serum lipid parameters and suicide ideation. Funnel-plot analysis suggested small study effects with publication bias. CONCLUSIONS Suicide attempts in people with schizophrenia spectrum disorders are associated with low mean total cholesterol levels.
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Affiliation(s)
- Anoop Sankaranarayanan
- Melaleuca Unit, Blacktown Mental Health, Western Sydney LHD Mental Health Service, Sydney, NSW, Australia.,School of Medicine and Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Robin Pratt
- Consultation-Liaison Psychiatry, Cairns Hospital, Cairns, Qld, Australia.,Faculty of Health Science and Medicine, Bond University, Robina, Qld, Australia
| | - Aparna Anoop
- Medical Student, The University of Buckingham Medical School, Buckingham, UK
| | - Angela Smith
- Research Librarian, HNE Health Libraries, Hunter New England Local Health District NSW, Waratah, NSW, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia.,UWS Clinical School, Blacktown Hospital, Blacktown, NSW, Australia
| | | | - Srinivasan Tirupati
- Psychiatric Rehabilitation Service, Hunter New England LHD Mental Health Service, Blacktown, NSW, Australia.,Faculty of Medicine, University of Newcastle, Callaghan, NSW, Australia
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Hjell G, Mørch-Johnsen L, Holst R, Tesli N, Bell C, Lunding SH, Rødevand L, Werner MCF, Melle I, Andreassen OA, Lagerberg TV, Steen NE, Haukvik UK. Disentangling the relationship between cholesterol, aggression, and impulsivity in severe mental disorders. Brain Behav 2020; 10:e01751. [PMID: 32681586 PMCID: PMC7507477 DOI: 10.1002/brb3.1751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Low total cholesterol has been linked with adverse mental symptoms such as aggression and impulsivity in severe mental disorders (SMDs). This putative association may affect the clinician's decision making about cholesterol lowering in this patient group. Here, we investigated the associations between cholesterol levels, aggression, and impulsivity in a large representative sample of in- and outpatients with SMD. METHODS Patients with schizophrenia- or bipolar spectrum disorders (N = 1 001) underwent thorough clinical characterization and blood sampling (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol). Aggression was characterized by the Positive and Negative Syndrome Scale Excited Component. Impulsivity was measured with the Barratt Impulsiveness Scale in a subsample of patients (N = 288). We used a multinomial logistic regression model to analyze the association between cholesterol and aggression and a multiple linear regression model to analyze the association between cholesterol and impulsivity, while controlling for confounders. RESULTS We found no significant associations between cholesterol levels and aggression or impulsivity. There were no significant interactions between cholesterol and diagnostic group or inpatient versus outpatient status. Controlling for medication use, body mass index, alcohol or illicit substance use did not affect the results. CONCLUSION In this large sample of patients with schizophrenia- and bipolar spectrum disorders, we found no associations between cholesterol levels and aggression or impulsivity. This has clinical implications as patients with SMD are at increased CVD risk and currently undertreated with statins.
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Affiliation(s)
- Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway
| | - Lynn Mørch-Johnsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway
| | - René Holst
- Departments of Psychiatry and Clinical Research, Ostfold Hospital, Gralum, Norway.,Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalia Tesli
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christina Bell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Andreas Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Unn Kristin Haukvik
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Adult Psychiatry, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Centre of Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Chen X, Xu J, Tang J, Dai X, Huang H, Cao R, Hu J. Dysregulation of amino acids and lipids metabolism in schizophrenia with violence. BMC Psychiatry 2020; 20:97. [PMID: 32131778 PMCID: PMC7055102 DOI: 10.1186/s12888-020-02499-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/14/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many studies have related biochemical characteristics to violence and have reported schizophrenia could elevated the risk of violent behaviour. However, the metabolic characteristics of schizophrenia patients with violence (V.SC) are unclear. METHODS To explore the metabolic characteristics of schizophrenia with violence and to identify potential biomarkers, untargeted metabolomics was performed by using gas chromatography time-of-flight mass spectrometry to analyse the plasma metabolites of fifty-three V.SC and twenty-four schizophrenia patients without violence (NV.SC). Multivariate and univariate analyses were performed to identify differential metabolites and biomarkers. Violence was assessed by the MacArthur Violence Assessment Study method. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale. RESULTS Multivariate analysis was unable to distinguish V.SC from NV.SC. Glycerolipid metabolism and phenylalanine, tyrosine and tryptophan biosynthesis were the differential metabolic pathways between V.SC and NV.SC. We confirmed ten metabolites and five metabolites as metabolic biomarkers of V.SC by random forest and support vector machine analysis, respectively. The biomarker panel, including the ratio of L-asparagine to L-aspartic acid, vanillylmandelic acid and glutaric acid, yielded an area under the receiver operating characteristic curve of 0.808. CONCLUSIONS This study gives a holistic view of the metabolic phenotype of schizophrenia with violence which is characterized by the dysregulation of lipids and amino acids. These results might provide information for the aetiological understanding and management of violence in schizophrenia; however, this is a preliminary metabolomics study about schizophrenia with violence, which needs to be repeated in future studies.
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Affiliation(s)
- Xiacan Chen
- Institute of Forensic Medicine, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China
| | - Jiajun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Tang
- Chengdu Compulsory Medical Center, Chengdu, China
| | - Xinhua Dai
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
| | - Haolan Huang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
| | - Ruochen Cao
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
| | - Junmei Hu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041 China
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Fang X, Chen Y, Wang Y, Zhang C. Identification of risk factors for suicidal ideation in patients with schizophrenia. Psychiatry Res 2019; 271:195-199. [PMID: 30500709 DOI: 10.1016/j.psychres.2018.11.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/05/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
Patients with schizophrenia have a high risk for suicide, and therefore, identification of risk factors for suicidal ideation (SI) may be helpful to reduce suicide rate. This study aimed to detect which clinical symptoms and biochemical parameters were most strongly associated with SI. A total of 174 patients and 35 healthy controls were enrolled in our study. Patients were evaluated by the Positive and Negative Syndrome Scale (PANSS), Scale of Assessment Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS) for psychiatric and depressive symptoms, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognitive function. We examined the levels of prolactin (PRL) and metabolic parameters in all participants. Our results showed a significantly increased level of PRL in patients compared to the controls before (t = 10.414, P < 0.001) and after (F = 31.308, P < 0.001) covariates were controlled for. In addition, we found that patients with SI had significantly higher PRL levels than those without SI (t = 2.586, P = 0.011). And there were positive correlations between serum PRL levels (r = 0.194, P = 0.010), serum fasting triglyceride levels (TG) (r = 0.188, P = 0.013), and RBANS visuospatial skill subscores (r = 0.162, P = 0.036) and SI severity. Finally, the stepwise multiple linear regression analysis revealed that SI severity was significantly associated with PRL levels, fasting TG levels and RBANS visuospatial skill subscores. This study provides support that greater cognitive ability, specifically visuospatial skill, PRL and TG, may confer an elevated risk for more severe SI in schizophrenia patients.
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Affiliation(s)
- Xinyu Fang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yan Chen
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yewei Wang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chen Zhang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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Cariou B, Challet-Bouju G, Bernard C, Marrec M, Hardouin JB, Authier C, Bach-Ngohou K, Leux C, Pichelin M, Grall-Bronnec M. Prevalence of hypobetalipoproteinemia and related psychiatric characteristics in a psychiatric population: results from the retrospective HYPOPSY Study. Lipids Health Dis 2018; 17:249. [PMID: 30400945 PMCID: PMC6220563 DOI: 10.1186/s12944-018-0892-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hypobetalipoproteinemia (HBL) is defined by plasma concentrations of LDL-cholesterol (LDL-C) lower than the fifth percentile for age and sex. Several psychiatric symptoms have been reported in association with HBL. The objective was to assess the prevalence of primary HBL in patients hospitalized in a psychiatric population and to better characterize the related psychiatric disorders. METHODS HYPOPSY is a retrospective study including 839 adults hospitalized in the Psychiatry department of Nantes University Hospital during the year 2014, except patients with eating disorders. The prevalence of primary HBL was defined by a plasma LDL-C concentration ≤ 50 mg/dL. Secondary causes of HBL were excluded after a review of medical records (n=2). Related-psychiatric disorders in patients with and without HBL were recorded using the ICD-10 classification. RESULTS Twenty cases of primary HBL (mean [SD] LDL-C: 42 [7] mg/dL) were diagnosed, leading to a prevalence of 2.39%. In comparison, the prevalence of HBL in a healthy control population was 0.57%. Psychiatric patients with HBL were characterized by a higher frequency of schizophrenia (p=0.044), hetero-aggression (p=0.015) and pervasive and specific developmental disorders (including autism) (p=0.011). CONCLUSIONS The prevalence of HBL is 4-fold higher in psychiatric than in general population. More specifically, some statistically significant associations were found between low LDL-C concentrations and schizophrenia, autism and hetero-aggression. These data reinforce the hypothesis for a link between genetically low LDL-C levels and psychiatric disorders.
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Affiliation(s)
- Bertrand Cariou
- CHU Nantes, l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, F-44000, Nantes, France. .,CHU de Nantes, CIC Endocrino-Nutrition INSERM UMR 1413, l'nstitut du thorax, F-44000, Nantes, France. .,Clinique d'Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital Guillaume & René Laennec, Boulevard Jacques Monod, Saint-Herblain, 44093, Nantes Cedex 1, France.
| | - Gaëlle Challet-Bouju
- CHU Nantes, Service d'Addictologie et de Psychiatrie, F-44000, Nantes, France.,Université de Nantes, Université de Tours, Inserm UMR 1246-SPHERE, F-44000, Nantes, France
| | - Céline Bernard
- Clinique d'Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital Guillaume & René Laennec, Boulevard Jacques Monod, Saint-Herblain, 44093, Nantes Cedex 1, France.,Present address: CHU Sud Reunion, Site Saint-Pierre, Avenue président F Mitterrand, BP 350, 97448 ST, Pierre Cedex, La Reunion, France
| | - Marie Marrec
- CHU de Nantes, CIC Endocrino-Nutrition INSERM UMR 1413, l'nstitut du thorax, F-44000, Nantes, France
| | - Jean-Benoit Hardouin
- Université de Nantes, Université de Tours, Inserm UMR 1246-SPHERE, F-44000, Nantes, France.,CHU Nantes, DRCi, Plateforme de Méthodologie et de Biostatistique, F-44000, Nantes, France
| | - Charlotte Authier
- Centre d'examens de santé de la Caisse Primaire d'Assurance Maladie de Loire-Atlantique, St Nazaire, F-44600, Saint-Nazaire, France
| | - Kalyane Bach-Ngohou
- CHU Nantes, Service de Biochimie, F-44000, Nantes, France.,INSERM1235, Université de Nantes, Institut des Maladies de l'Appareil Digestif, F-44000, Nantes, France
| | - Christophe Leux
- CHU Nantes, Service d'Information Médicale, F-44000, Nantes, France
| | - Matthieu Pichelin
- CHU Nantes, l'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, F-44000, Nantes, France.,CHU de Nantes, CIC Endocrino-Nutrition INSERM UMR 1413, l'nstitut du thorax, F-44000, Nantes, France.,Clinique d'Endocrinologie, Maladies Métaboliques et Nutrition, Hôpital Guillaume & René Laennec, Boulevard Jacques Monod, Saint-Herblain, 44093, Nantes Cedex 1, France
| | - Marie Grall-Bronnec
- CHU Nantes, Service d'Addictologie et de Psychiatrie, F-44000, Nantes, France. .,Université de Nantes, Université de Tours, Inserm UMR 1246-SPHERE, F-44000, Nantes, France.
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Serum high-sensitivity C-reactive protein: A delicate sentinel elevated in drug-free acutely agitated patients with schizophrenia. Psychiatry Res 2016; 246:89-94. [PMID: 27669496 DOI: 10.1016/j.psychres.2016.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 09/04/2016] [Accepted: 09/20/2016] [Indexed: 12/28/2022]
Abstract
Increased levels of high-sensitivity C reactive protein (hsCRP) have been reported in schizophrenia, but to date, no study is designed to examine serum hsCRP in acutely agitated patients with schizophrenia, an extreme state that requires immediate diagnosis and medical treatment. Serum hsCRP levels were assessed in 32 clinically acutely agitated patients and 42 healthy control subjects matched for demographic properties. Further, serum hsCRP levels in acutely agitated patients were compared with control subjects and with the levels after the patients were treated with anti-psychiatric medications. Meanwhile, the influence of clinical subtypes, family history, and gender, as well as the levels of white blood cell (WBC) counts were also considered. In results, serum hsCRP levels were significantly higher in acutely agitated patients with schizophrenia than in healthy subjects. The elevation of serum hsCRP in patients was not affected by gender, family history (P>0.05), and clinical classification of schizophrenia (P>0.05). However, the elevation of hsCRP was suppressed by the medical treatment for schizophrenia with acute agitation (P<0.05). In addition, WBC counts, another inflammation-related indicator, were also increased significantly in acutely agitated patients compared with healthy subjects, consistent with the elevation of serum hsCRP. In conclusion, hsCRP is an important indicator of immune alterations in the pathogenesis of schizophrenia and has potential to be developed into a sensitive marker for the acute agitation in schizophrenia.
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Mensi R, Messaoud A, Mhallah A, Azizi I, Salah WH, Douki W, Najjar MF, Gaha L. The association between altered lipid profile and suicide attempt among Tunisian patients with schizophrenia. Ann Gen Psychiatry 2016; 15:36. [PMID: 28018476 PMCID: PMC5162100 DOI: 10.1186/s12991-016-0123-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been many studies on psychiatric disorders, but very little is known about the biology of suicide with schizophrenia. In the present study, we are looking for a possible connection between altered lipid profile and suicidal behavior in schizophrenic Tunisian patients. METHODS Assay of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) has been done for 126 schizophrenic patients with and without suicide attempts and 131 healthy controls recruited in the University Hospital of Monastir. RESULTS TC and LDL-c levels were significantly higher in schizophrenic patients compared to controls. TC was significantly lower in schizophrenic patients with suicide attempt compared to those without suicide attempt. Depending to the sonority of suicide attempt, TC was significantly lower in patients with recent suicide attempt compared to those with lifetime suicide attempt and without suicide attempt (p < 0.001), and no significant differences between TG, LDL-c, and HDL-c were noted. CONCLUSIONS Results of this study showed that TC levels in schizophrenic patients after a recent suicide attempt are significantly lower than in patients without suicide attempt and with lifetime suicide attempts. TC can be one of biological markers defined suicidal risk for schizophrenic patients.
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Affiliation(s)
- Rym Mensi
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Amal Messaoud
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Ahmed Mhallah
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Department of Psychiatry, University Hospital in Monastir, Monastir, Tunisia
| | - Islem Azizi
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Walid Haj Salah
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Department of Psychiatry, University Hospital in Monastir, Monastir, Tunisia
| | - Wahiba Douki
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Mohamed Fadhel Najjar
- Clinical Biochemistry and Toxicology Laboratory, University Hospital in Monastir, Monastir, Tunisia
| | - Lotfi Gaha
- Research Laboratory "Vulnerability to Psychotic Disorders LR05ES10", Faculty of Medicine, University of Monastir, 5012 Monastir, Tunisia ; Department of Psychiatry, University Hospital in Monastir, Monastir, Tunisia
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10
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Wu S, Ding Y, Wu F, Xie G, Hou J, Mao P. Serum lipid levels and suicidality: a meta-analysis of 65 epidemiological studies. J Psychiatry Neurosci 2016; 41:56-69. [PMID: 26505144 PMCID: PMC4688029 DOI: 10.1503/jpn.150079] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to determine the association between serum lipid levels and suicidality, as evidence from previous studies has been inconsistent. METHODS We identified relevant studies by searching Medline, Web of Science, EMBASE, and the Cochrane Database of Systematic Reviews (1980 to Dec. 5, 2014). Studies assessing the association between serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) levels and suicidality were included. We used a random-effects model to take into account heterogeneity among studies. RESULTS We included 65 studies with a total of 510 392 participants in our analysis. Compared with the nonsuicidal patients, suicidal patients had significantly lower serum TC (weighted mean difference [WMD] -22.35, 95% confidence interval [CI] -27.95 to -16.75), LDL-C (WMD -19.56, 95% CI -26.13 to -12.99) and TG (WMD -23.40, 95% CI -32.38 to -14.42) levels, while compared with the healthy controls, suicidal patients had significantly lower TC (WMD -24.75, 95% CI -27.71 to -21.78), HDL-C (WMD -1.75, 95% CI -3.01 to -0.48) and LDL-C (WMD -3.85, 95% CI -7.45 to -0.26) levels. Furthermore, compared with the highest serum TC level category, a lower serum TC level was associated with a 112% (95% CI 40%-220%) higher risk of suicidality, including a 123% (95% CI 24%-302%) higher risk of suicide attempt and an 85% (95 CI 7%-221%) higher risk of suicide completion. The cut-off values for low and high serum TC level were in compliance with the categories reported in the original studies. LIMITATIONS A major limitation of our study is the potential heterogeneity in most of the analyses. In addition, the suicidal behaviour was examined using different scales or methods across studies, which may further explain heterogeneity among the studies. CONCLUSION We identified an inverse association between serum lipid levels and suicidality. More mechanistic studies are needed to further explain this association.
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Affiliation(s)
| | | | | | | | - Jun Hou
- Correspondence to: P. Mao or J. Hou, Research Center for Clinical Medicine, the 302nd Hospital of PLA, No. 100 of West Fourth Ring Middle Road, Beijing, China, 100039; or
| | - Panyong Mao
- Correspondence to: P. Mao or J. Hou, Research Center for Clinical Medicine, the 302nd Hospital of PLA, No. 100 of West Fourth Ring Middle Road, Beijing, China, 100039; or
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Chen SC, Chu NH, Hwu HG, Chen WJ. Trajectory classes of violent behavior and their relationship to lipid levels in schizophrenia inpatients. J Psychiatr Res 2015; 66-67:105-11. [PMID: 26004299 DOI: 10.1016/j.jpsychires.2015.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 04/25/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the trajectory patterns of violence in schizophrenia inpatients, examine the relationships between the violence trajectories and baseline clinical features and lipid levels, and generate a model to predict the more violent trajectories. METHODS In a sample of 107 consecutively admitted patients with schizophrenia spectrum disorders, violent behavior was weekly rated using the Violence Scale. The patients' blood levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were measured at admission. A trajectory analysis was used to classify the patients' longitudinal courses in violence, and the correlates of these trajectories were assessed using multinomial logistic regression analyses. A stepwise logistic regression was used to select the best predictor variables for the more violent trajectories. RESULTS Four violence trajectories of inpatients were obtained: class 1 (no violence, 37.4%), class 2 (low-leveling off, 39.2%), class 3 (high-falling sharply, 10.3%), and class 4 (high-falling slowly, 13.1%). Although the relationship between decreasing TC and TG levels and increased violence in the trajectory classes did not reach statistical significance, a decreasing trend in the proportion of high dichotomized-TG levels was significantly associated with more violence in the trajectory classes (p = 0.04). A five-variable model consisting of female gender, early onset, higher scores of positive symptoms, lower scores of negative symptoms, and low dichotomized-TC levels had a predictive accuracy of 0.85 (95% CI = 0.72-0.97). CONCLUSIONS Distinct violence trajectories exist in schizophrenia inpatients, and the more violent trajectories can be predicted using baseline clinical features and lipid levels.
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Affiliation(s)
- Shing-Chia Chen
- School of Nursing, College of Medicine and National Taiwan University Hospital, National Taiwan University, Taipei 100, Taiwan
| | - Ni-Hsuan Chu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan
| | - Hai-Gwo Hwu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Wei J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
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Misiak B, Kiejna A, Frydecka D. Higher total cholesterol level is associated with suicidal ideation in first-episode schizophrenia females. Psychiatry Res 2015; 226:383-8. [PMID: 25618471 DOI: 10.1016/j.psychres.2014.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/06/2014] [Accepted: 12/19/2014] [Indexed: 01/08/2023]
Abstract
There are inconsistent reports showing that the relationship between total cholesterol (TC) level and suicidality might be gender-specific. We compared 30 first-episode schizophrenia (FES) patients reporting suicidal ideation based on the Operational Criteria for Psychotic Illness (OPCRIT) checklist with 70 FES patients, who have never experienced suicidal ideation. After controlling for potential confounders, higher TC was associated with suicidal ideation only in FES females. Future studies should disentangle biological underpinnings of this gender-specific association.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland; Department of Genetics, Wroclaw Medical University, 1 Marcinkowski Street, 50-368 Wroclaw, Poland.
| | - Andrzej Kiejna
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wroclaw, Poland
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da Graça Cantarelli M, Nardin P, Buffon A, Eidt MC, Antônio Godoy L, Fernandes BS, Gonçalves CA. Serum triglycerides, but not cholesterol or leptin, are decreased in suicide attempters with mood disorders. J Affect Disord 2015; 172:403-9. [PMID: 25451444 DOI: 10.1016/j.jad.2014.10.033] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/14/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many peripheral biomarkers, including low cholesterol and its fractions, have been examined to identify suicidal behavior. Herein, we assessed serum lipid profile and some proteins putatively associated with suicidal behavior in subjects with mood disorder (bipolar disorder or major depressive disorder) with a recent suicide attempt and with no lifetime history of suicide attempts. METHODS Fifty subjects had presented an episode of attempted suicide during the last 15 days, and 36 subjects had no history of any suicide attempt. We measured total cholesterol, HDL, LDL and triglycerides as well as serum leptin, brain-derived neurotrophic factor (BDNF), S100B and C-reactive protein (CRP). RESULTS Individuals that had attempted suicide presented decreased body mass index (BMI) and waist circumference. After adjusting for these confounders, we found that triglycerides were decreased in attempted suicide subjects. We found no differences among total cholesterol, LDL, and HDL or leptin, S100B, CRP and BDNF. LIMITATIONS This is a cross-sectional study, and we cannot therefore assess whether a decrease in triglycerides caused a mood episode with suicidal ideation that led to a suicide attempt or if the presence of a mood episode originated a loss of appetite and consequent loss of weight, therefore decreasing triglyceride levels. CONCLUSIONS These results do not support the hypothesis that lower levels of cholesterol are associated with suicidal behavior in a mood disorder sample. However, our data support the idea that adiposity is differentiated in these patients (reduced BMI, waist circumference and serum triglycerides), which could lead to an altered communication between the adipose tissue and brain.
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Affiliation(s)
| | - Patrícia Nardin
- Laboratory of Calcium Binding Proteins in the Central Nervous System, Post Graduate Program in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andréia Buffon
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Brisa S Fernandes
- Laboratory of Calcium Binding Proteins in the Central Nervous System, Post Graduate Program in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carlos-Alberto Gonçalves
- Post Graduate Program in Neuroscience, Federal University of Rio Grande do Sul,Porto Alegre, Brazil; Laboratory of Calcium Binding Proteins in the Central Nervous System, Post Graduate Program in Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Cantarelli MDG, Tramontina AC, Leite MC, Gonçalves CA. Potential neurochemical links between cholesterol and suicidal behavior. Psychiatry Res 2014; 220:745-51. [PMID: 25457283 DOI: 10.1016/j.psychres.2014.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 10/07/2014] [Accepted: 10/16/2014] [Indexed: 12/16/2022]
Abstract
The role of cholesterol in psychiatric diseases has aroused the interest of the medical community, particularly in association with violent and suicidal behavior. Herein, we discuss some aspects of brain cholesterol metabolism, exploring possible mechanisms underlying the findings and reviewing the available literature on the possible neurochemical link between suicide and low or reduced levels of serum cholesterol. Most of the current hypotheses suggest a decreased serotonergic activity due to a decrease in cholesterol in the lipid rafts of synaptic membranes. Some aspects and limitations of this assumption are emphasized. In addition to serotonin hypofunction, other mechanisms have been proposed to explain increased impulsivity in suicidal individuals, including steroid modulation and brain-derived neurotrophic factor decrease, which could also be related to changes in lipid rafts. Other putative markers of suicidal behavior (e.g. protein S100B) are discussed in connection with cholesterol metabolism in the brain tissue.
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Ainiyet B, Rybakowski JK. Suicidal behavior in schizophrenia may be related to low lipid levels. Med Sci Monit 2014; 20:1486-90. [PMID: 25141886 PMCID: PMC4148359 DOI: 10.12659/msm.890884] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Lifetime suicide mortality in people with schizophrenia is approximately 4–5%, which is higher than in the general population. In mood disorders, many studies and meta-analyses have shown a link between suicidal behavior and low lipid levels, especially that of cholesterol, and some studies have also suggested such a relationship in schizophrenia. Therefore, the aim of the present study was to investigate a possible correlation between suicidal behavior and lipid levels in schizophrenia patients recently admitted to a psychiatric hospital. Material/Methods Our study included 148 (69 males, 79 females) schizophrenia patients with a mean age of 32±10 years, all recently admitted due to acute exacerbation of their mental illness. Psychometric and laboratory assessments were made within 24–72 hours after hospital admission. The main purpose of the interview was to assess occurrence of any suicidal thoughts, suicidal tendencies, and/or suicide attempts during the 3 months prior to admission. Serum total, LDL and HDL cholesterol, as well as triglycerides and total lipids were measured. Results A significant association was found between suicidal thoughts and attempts and low total cholesterol, LDL cholesterol, triglycerides, and total lipids, in both male and female patients. In male patients with suicidal tendencies, correlation with low LDL cholesterol and triglycerides did not reach statistical significance. No association with suicidality was found with HDL cholesterol in subjects studied. Conclusions The results obtained suggest that, similar to depressed patients, low total and LDL cholesterol, triglycerides, and total lipids can be state-dependent risk factors for suicidal behavior in Polish patients with schizophrenia.
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Affiliation(s)
- Babajohn Ainiyet
- Department of Psychiatry, Akerhus Universytetssykehus, Oslo, Norway
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznań University of Medical Sciences, Poznań, Poland
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16
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Zhang J. Epidemiological link between low cholesterol and suicidality: A puzzle never finished. Nutr Neurosci 2013; 14:268-87. [DOI: 10.1179/1476830511y.0000000021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Current suicidality and previous suicidal attempts in patients with schizophrenia are associated with different dimensions of temperament and character. Psychiatry Res 2012; 200:120-5. [PMID: 22560807 DOI: 10.1016/j.psychres.2012.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 04/11/2012] [Accepted: 04/13/2012] [Indexed: 02/06/2023]
Abstract
Suicide is a major public health problem and the leading cause of premature death in patients with schizophrenia. Information about the patient's personality is helpful for assessing the risk of suicide attempts and suicidal ideation. The sample consisted of 120 outpatients with a diagnosis of schizophrenia, 29 of whom had previously attempted suicide. We used the Temperament and Character Inventory to assess personality differences between patients who had previously attempted and had not previously attempted suicide and between patients who had and did not have current suicidal ideation. Current suicidal ideation was assessed using the four-point severity scale, which is item nine from the Beck Depression Inventory. The character dimension Self-transcendence was shown by logistic regression to be a predictor of lifetime suicide attempts. Low Self-directedness was shown to be a predictor of current suicidal ideation. To prevent suicidal behaviour, it is important to better understand the personality traits associated with suicidal ideation and suicide attempts. Suicide attempts and suicidal ideation in schizophrenia may not represent the same phenomenon ranging on a single continuum. The importance of these results suggests that further study is needed.
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Olié E, Picot MC, Guillaume S, Abbar M, Courtet P. Measurement of total serum cholesterol in the evaluation of suicidal risk. J Affect Disord 2011; 133:234-8. [PMID: 21521628 DOI: 10.1016/j.jad.2011.03.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 02/18/2011] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many studies have demonstrated an association between suicidal behavior and low levels of total serum cholesterol. To our knowledge, this association has mainly been reported in men. This case-control study was undertaken to assess the association between serum cholesterol level and suicide attempts in both genders. METHODS A total of 3207 subjects was included, divided into three groups: 510 patients with a history of suicidal attempts, 275 patients with no history of suicidal attempts, and 2422 controls. Mean and quartile total cholesterol levels were compared between the three groups according to gender. ROC curves were drawn to determine the biologically relevant threshold. RESULTS After adjustment for age, cholesterol level was significantly lower (p<0.01) in suicide attempters than in non-attempters and controls for both genders. Male non-suicide attempters had similar cholesterol levels to controls (p=0.7), but the levels in female non-attempters were significantly higher (p=0.004). The proportion of suicide attempters in the lowest cholesterol level quartile (51.3% of men, 40.1% of women) was significantly higher than that in the highest quartile (8.1% of men, 12.4% of women). For triglyceride level, no difference was found between the three groups, suggesting that this association was not due to malnutrition linked to depression. LIMITATIONS The effect of acute or chronic administration of medications on serum cholesterol levels was not controlled. Psychiatric history in surgical controls was not recorded. CONCLUSIONS Total serum cholesterol levels measured at admission may be a useful biological marker of suicidal risk.
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Affiliation(s)
- Emilie Olié
- Université Montpellier 1, Montpellier, France
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19
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Fiedorowicz JG, Coryell WH. Cholesterol and suicide attempts: a prospective study of depressed inpatients. Psychiatry Res 2007; 152:11-20. [PMID: 17360043 PMCID: PMC1965495 DOI: 10.1016/j.psychres.2006.09.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 06/08/2006] [Accepted: 09/08/2006] [Indexed: 10/23/2022]
Abstract
Low cholesterol levels have commonly been associated with various suicide measures. We sought to examine suicide attempts in a prospective sample of depressed patients that on prior analysis demonstrated an association between low cholesterol and subsequent suicide completions. Seventy-four inpatients with Research Diagnostic Criteria unipolar major depression, bipolar depression or schizoaffective depression entered a prospective follow-up study from 1978 to 1981. Kaplan-Meier survival analysis and Cox regression were utilized to elucidate the relationship between cholesterol levels and subsequent severe suicide attempts as well as all suicide attempts regardless of severity. Attempts preceding index hospitalization and other lifetime attempts were evaluated cross-sectionally. Low serum cholesterol levels did not predict subsequent suicide attempts. Contrary to our hypothesis, the high cholesterol group was associated with increased risk of suicide attempts on survival analysis in those less than median age. Nonetheless, in cross-sectional analysis, the low cholesterol group had more suicide attempts preceding index hospitalization and more remote lifetime attempts. The results from this prospective dataset do not support an association between low cholesterol and subsequent suicide attempts despite replicating the retrospective findings of previous case-control and cross-sectional studies.
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Affiliation(s)
- Jess G Fiedorowicz
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive W279 GH, Iowa City, IA 52242, USA.
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Abstract
There is a high prevalence of suicidal behavior in individuals suffering from schizophrenia and recent investigations substantially elucidate this problem and provide useful insights about clinical risk factors, neurobiologic underpinnings and the impact of various treatments on reducing such behavior. The risk of suicide is greatest early in the course of schizophrenic illness but continues throughout life; risk factors for suicidal behavior include psychosis, depression and substance abuse. Effectively treating positive symptoms and depression, reducing substance abuse, avoiding akathisia, addressing demoralization and instilling hope are important elements in this treatment approach. The newer generation of atypical antipsychotics (particularly clozapine) and new psychologic approaches (particularly cognitive behavioral therapy) appear to be useful in reducing suicidality in schizophrenia. The significant advances in defining the neurobiologic basis of suicidality may enable the development of more effective treatments. The renewed emphasis on resilience and recovery as desired outcomes in schizophrenia and the accompanying sense of hope encourage optimism about effectively reducing suicidality in schizophrenia. Over the past 10 years, much has been learnt and hopefully this momentum will be translated into increasingly better outcomes.
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Affiliation(s)
- Rajiv Tandon
- Department of Children and Families, Office of Mental Health, State of Florida, USA.
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Gavaudan G, Besnier N, Lançon C. Suicide et schizophrénie : évaluation du risque et prévention. ANNALES MEDICO-PSYCHOLOGIQUES 2006. [DOI: 10.1016/j.amp.2005.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jow GM, Yang TT, Chen CL. Leptin and cholesterol levels are low in major depressive disorder, but high in schizophrenia. J Affect Disord 2006; 90:21-7. [PMID: 16324751 DOI: 10.1016/j.jad.2005.09.015] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 09/19/2005] [Accepted: 09/20/2005] [Indexed: 12/20/2022]
Abstract
BACKGROUND Appetite, food intake and weight are frequently altered in psychiatric disorders such as major depression and schizophrenia. Leptin is an adipocyte hormone, as the product of the ob gene, regulating food intake and energy balance providing the hypothalamus with information on the amount of body fat. Leptin seems to be strongly associated with lipid metabolism. Moreover, leptin is involved in the control of other behaviors and in brain development. There are few studies about the amounts of plasma leptin in mood disorder and schizophrenia with inconsistent findings. The relationship between leptin and major depressive disorder is still unknown. We planned to investigate the relationship of the serum leptin concentration, cholesterol, and BMI between patients with major depressive disorder, schizophrenic patients and healthy control subjects. METHODS In the present study, the BMI, plasma cholesterol and leptin levels, BDI, and BPRS were compared in 69 patients with major depressive disorder, 78 schizophrenic patients, and 51 healthy controls. RESULTS The major findings of our study included (1) leptin and cholesterol levels were low in patients with major depressive disorder, but high in schizophrenic patients; (2) negative correlations between BDI scores and serum cholesterol or leptin levels in the patients with major depressive disorder; (3) an inconsistently positive correlation between mean leptin levels, cholesterol, and BMI among different groups; (4) positive correlations between serum cholesterol or leptin levels and the length of illness in the schizophrenic patients. CONCLUSIONS In this study, our results indicate that that leptin and cholesterol might play differently important pathophysiological roles in these psychiatric disorders.
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Affiliation(s)
- Guey-Mei Jow
- School of Medicine, Fu Jen Catholic University, Hsin-Chuang, Taipei Hsien 24205, Taiwan
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Huang TL, Chen JF. Serum lipid profiles and schizophrenia: effects of conventional or atypical antipsychotic drugs in Taiwan. Schizophr Res 2005; 80:55-9. [PMID: 15964176 DOI: 10.1016/j.schres.2005.05.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Revised: 04/29/2005] [Accepted: 05/04/2005] [Indexed: 11/26/2022]
Abstract
This study investigated the relationships between serum lipid profiles and schizophrenia and the effects of conventional or atypical antipsychotic drugs on serum lipid profiles. During a 1-year period, fasting blood samples for serum lipid profiles were collected from 126 schizophrenic patients and 59 healthy control subjects. The serum lipid profiles were detected by enzymatic determination. Patients were assessed for disease severity at baseline and endpoint at 3 weeks using the Positive and Negative Syndrome Scale. At baseline, patients with acute-phase schizophrenia had lower high-density lipoprotein (HDL) levels, higher low-density lipoprotein (LDL) levels, and higher ratios of total cholesterol/high-density lipoprotein (TC/HDL) and LDL/HDL than healthy control subjects. At endpoint, after a 3-week treatment with antipsychotics, the blood samples of the 97 schizophrenic patients were assessed again. Responders to antipsychotic treatment (n = 68) but not nonresponders (n = 29) had significantly increased TC, triglyceride (TG), and very low-density lipoprotein (VLDL) levels and decreased ratio of LDL/HDL. Experimental findings also showed significantly increased TC, TG, HDL, and VLDL levels and decreased ratio of LDL/HDL in responders taking atypical antipsychotic drugs (n = 32), but not in patients treated with conventional antipsychotic drugs (n = 36). In conclusion, this study identified strong associations between dyslipidemia and acute-phase schizophrenia and dyslipidemia and responders taking atypical antipsychotics; both associations would increase the risk of developing diabetes and coronary heart disease.
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Affiliation(s)
- Tiao-Lai Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, 123, Ta-Pei Rd, Niao-Sung, Kaohsiung 833, Taiwan, ROC.
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Deisenhammer EA, Kramer-Reinstadler K, Liensberger D, Kemmler G, Hinterhuber H, Fleischhacker WW. No evidence for an association between serum cholesterol and the course of depression and suicidality. Psychiatry Res 2004; 121:253-61. [PMID: 14675744 DOI: 10.1016/j.psychres.2003.09.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a number of previous reports, an association of altered, in most cases lower, serum cholesterol levels with depression, suicidal ideation and current or past suicidal behavior has been suggested. In this investigation, the course of serum cholesterol concentrations was measured in depressed patients during treatment. Ninety-two inpatients with a major depressive episode were included. Serum lipid concentrations were assessed at admission, after 1 week and after 4 weeks of antidepressant treatment. Degrees of depression and suicidality were measured with the Hamilton Depression Rating Scale. Although there was a significant reduction in depression and suicidality scores, neither a significant change in serum cholesterol levels nor a correlation between cholesterol levels and clinical improvement was found. Further, there were no significant differences in lipid levels between patients with and without a history of attempted suicide. In patients who had used a violent method, there was a trend for lower total cholesterol levels compared to those who had poisoned themselves. The results of this study do not support the hypothesis of an association of serum cholesterol with the course of depression and suicidal ideation. Cholesterol levels do not appear to be an appropriate biological marker for suicidality during the first 4 weeks of treatment in patients with a major depressive episode.
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Affiliation(s)
- Eberhard A Deisenhammer
- Department of General Psychiatry, Innsbruck University Hospital, Anichstrasse 35, A-6020, Innsbruck, Austria.
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Atmaca M, Kuloglu M, Tezcan E, Ustundag B. Serum leptin and cholesterol levels in schizophrenic patients with and without suicide attempts. Acta Psychiatr Scand 2003; 108:208-14. [PMID: 12890276 DOI: 10.1034/j.1600-0447.2003.00145.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Previous studies demonstrate a relationship between lipid metabolism and suicide or impulsive-aggressive behaviours. Leptin seems to be related with lipid metabolism. Therefore, the aim was to measure total serum cholesterol and leptin levels in 16 medication-free schizophrenic patients with and without suicide attempts and in 16 healthy controls. METHOD Subjects were assessed by using Impulsivity Rating (IRS) and Modified Overt Aggression Scale (MOAS). RESULTS The patients had lower total cholesterol and leptin levels in serum compared with the controls. Significantly lower total cholesterol and leptin levels were observed in patients who had attempted suicide compared with those who had not. The levels were observed to be low in violent attempters when compared with non-violent attempters. MOAS and IRS scores were negatively correlated with both cholesterol or leptin levels in patients. CONCLUSION The results indicated that medication-free schizophrenic patients have statistically significant lower serum cholesterol and leptin levels compared with controls and the difference is obvious in suicide attempters compared with non-suicide attempters and in violent attempters than non-violent attempters.
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Affiliation(s)
- M Atmaca
- Departments of Psychiatry and Clinical Biochemistry, Firat University, School of Medicine, Elazig, Turkey.
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Abstract
A meta-analysis was performed on studies exploring the link between low levels of serum cholesterol and increased risk of suicide. Follow-up studies found that those with lower cholesterol levels do have a tiny but statistically significant increased risk of completing suicide. Individuals who have attempted suicide in the past have lower cholesterol levels, especially if they used violent methods for suicide. Cholesterol lowering studies, however, did not lead to a significant increase in completed suicide.
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Affiliation(s)
- David Lester
- Psychology Program, The Richard Stockton College of New Jersey, Pomona 08240-0195, USA.
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