Müller-Oerlinghausen B, Roggenbach J
Former Clinical Psychopharmacology Research Group, Department of Psychiatry, Freie Universität Berlin, Germany.
Pharmacopsychiatry. 2002 Mar;35(2):44-9. doi: 10.1055/s-2002-25030.
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.
对与自杀行为相关的血清素能参数的研究得出了许多不一致且模糊的结果。在本综述中，我们试图列举一些生物自杀研究中方法学和概念上的模糊性及陷阱的例子。现有文献指出了在解释该领域现有数据时需考虑的各种关键问题：
-- “自杀倾向”这一概念在生物自杀研究中并无用处。自我毁灭倾向大多出现在自杀成功者中，在许多自杀未遂者和有自杀念头的个体中可能并不存在。在自杀意图与伤害、自杀意图与自杀风险、自杀方法的选择（暴力与非暴力）与自杀风险、自杀念头或自杀未遂之间，尚未发现一致的关联。不同程度和不同形式的自杀行为之间，尚未以任何程度的一致性证明存在密切关系。根据许多研究，血清素能标志物与自杀行为的各种性质和强度并无关联。
-- 自杀倾向与冲动性或攻击性之间的关联较弱。可能存在冲动和攻击控制方面的障碍，但仅在一部分“有自杀倾向”的患者中存在。
-- 在生物自杀研究中，使用抑郁症的疾病分类概念来描述有自杀倾向的个体可能会产生误导。生物变量可能与特定的抑郁症状相关，但与某些疾病分类概念或抑郁评定量表的总分无关。
-- 所谓的外周和中枢血清素能参数之间的关联是基于缺乏充分证据的假设。多项研究表明，中枢和外周血清素能参数的变化之间并无相关性。外周血清素能参数变化的机制尚未得到充分理解。
