Träskman-Bendz L, Alling C, Oreland L, Regnéll G, Vinge E, Ohman R
Department of Psychiatry, University Hospital, Lund, Sweden.
J Clin Psychopharmacol. 1992 Apr;12(2 Suppl):21S-26S.
Biochemical studies related with suicidal behavior have mainly dealt with monoaminergic and corticosteroidal measures. We used some of these measures in a study of 61 suicide attempters who, except for occasional doses of benzodiazepines, had been medication free for a mean of 16 days. The monoamine metabolites 5-hydroxyindoleacetic acid, homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol were measured in lumbar cerebrospinal fluid (CSF). We found that violent suicide attempters (N = 18) had 5-hydroxyindoleacetic acid concentrations below the median of all patients, whereas the concentrations of 3-methoxy-4-hydroxyphenylglycol were mainly above the median. We found no significant differences between violent and nonviolent (N = 43) attempters concerning CSF homovanillic acid, 24-hour urinary norepinephrine-epinephrine and cortisol, activity of monoamine oxidase in platelets, or post-dexamethasone plasma cortisol. Four patients completed suicide, and 3 of them had CSF 5-hydroxyindoleacetic acid concentrations at or below the median. All completed suicides had CSF 3-methoxy-4-hydroxyphenylglycol concentrations above the median. Urinary measures and platelet monoamine oxidase activity of completed suicides were in the higher concentration ranges. Patients who repeated suicidal behavior after the index investigation had low 24-hour urinary cortisol levels more often than those who did not repeat. Because our subgroups of patients are small, we cannot draw any firm conclusions about the value of our CSF and urinary biochemical findings predicting suicidal behavior. However, our CSF findings in violent suicide attempters are similar to those observed in other studies.
与自杀行为相关的生化研究主要涉及单胺能和皮质类固醇指标。我们在一项针对61名自杀未遂者的研究中采用了其中一些指标，这些自杀未遂者除偶尔服用苯二氮䓬类药物外，平均16天未服用任何药物。在腰椎脑脊液（CSF）中测量了单胺代谢产物5-羟吲哚乙酸、高香草酸和3-甲氧基-4-羟基苯乙二醇。我们发现，暴力自杀未遂者（N = 18）的5-羟吲哚乙酸浓度低于所有患者的中位数，而3-甲氧基-4-羟基苯乙二醇的浓度主要高于中位数。在脑脊液高香草酸、24小时尿去甲肾上腺素-肾上腺素和皮质醇、血小板中单胺氧化酶的活性或地塞米松后血浆皮质醇方面，暴力自杀未遂者与非暴力自杀未遂者（N = 43）之间未发现显著差异。4名患者自杀身亡，其中3人的脑脊液5-羟吲哚乙酸浓度处于或低于中位数。所有自杀身亡者的脑脊液3-甲氧基-4-羟基苯乙二醇浓度均高于中位数。自杀身亡者的尿液指标和血小板单胺氧化酶活性处于较高浓度范围。在指数调查后重复自杀行为的患者，其24小时尿皮质醇水平低于未重复自杀行为的患者。由于我们的患者亚组规模较小，我们无法就脑脊液和尿液生化指标预测自杀行为的价值得出任何确凿结论。然而，我们在暴力自杀未遂者中获得的脑脊液研究结果与其他研究中观察到的结果相似。
