Placidi G P, Oquendo M A, Malone K M, Huang Y Y, Ellis S P, Mann J J
Center for the Study of Suicidal Behavior, Department of Neuroscience, New York State Psychiatric Institute, New York, New York, USA.
Biol Psychiatry. 2001 Nov 15;50(10):783-91. doi: 10.1016/s0006-3223(01)01170-2.
We have proposed a stress-diathesis model for suicidal behavior, in which major depression is a stressor and the diathesis is shared with aggression. Neurotransmitter correlates of the stress or diathesis have not been adequately evaluated by previous studies, because they did not simultaneously examine the relationship of multiple neurotransmitters to all three psychopathologies in the same population. In the present study we investigated the relationship of monoamine metabolites to aggressivity, suicidal behavior, and depression in patients with mood disorders.
Ninety-three drug-free subjects with a major depressive episode underwent lumbar puncture and psychiatric evaluation. Cerebrospinal fluid CSF levels of 5hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA) and methoxy-hydroxy-phenylglycol (MHPG) were assayed. The relationships between monoamine metabolites and clinical variables were statistically evaluated.
Higher lifetime aggressivity correlated significantly with lower CSF 5-HIAA. Lower CSF 5-HIAA and greater suicidal intent were found in high-lethality suicide attempters compared with low-lethality suicide attempters. Low-lethality attempters did not differ biologically from nonattempters. No correlation between CSF HVA and any of the psychopathological variables was found. Only aggression showed a trend statistically in correlating positively with CSF MHPG levels.
Lower CSF 5-HIAA concentration was independently associated with severity of lifetime aggressivity and a history of a higher lethality suicide attempt and may be part of the diathesis for these behaviors. The dopamine and norepinephrine systems do not appear to be as significantly involved in suicidal acts, aggression, or depression. The biological correlates of suicide intent warrant further study.
我们提出了一种自杀行为的应激-素质模型，其中重度抑郁症是一种应激源，而素质与攻击性相关。先前的研究尚未充分评估应激或素质与神经递质的相关性，因为它们没有在同一人群中同时研究多种神经递质与所有三种精神病理学之间的关系。在本研究中，我们调查了情绪障碍患者单胺代谢产物与攻击性、自杀行为和抑郁之间的关系。
93名无药物治疗史且患有重度抑郁发作的受试者接受了腰椎穿刺和精神评估。检测脑脊液（CSF）中5-羟吲哚乙酸（5-HIAA）、高香草酸（HVA）和甲氧基-羟基-苯乙二醇（MHPG）的水平。对单胺代谢产物与临床变量之间的关系进行了统计学评估。
较高的终生攻击性与较低的脑脊液5-HIAA显著相关。与低致死性自杀未遂者相比，高致死性自杀未遂者脑脊液5-HIAA水平较低且自杀意图更强。低致死性未遂者与未尝试者在生物学上无差异。未发现脑脊液HVA与任何精神病理变量之间存在相关性。只有攻击性在统计学上显示出与脑脊液MHPG水平呈正相关的趋势。
较低的脑脊液5-HIAA浓度与终生攻击性的严重程度和高致死性自杀未遂史独立相关，可能是这些行为素质的一部分。多巴胺和去甲肾上腺素系统似乎在自杀行为、攻击性或抑郁中没有那么显著的参与。自杀意图的生物学相关性值得进一步研究。
