Sudol Katherin, Mann J John
Frank H. Netter MD School of Medicine, Quinnipiac University, 370 Bassett Road, North Haven, CT, 06473, USA.
Department of Psychiatry, Columbia University College of Physicians and Surgeons, Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, 1051 Riverside Drive, Box 42, New York, NY, 10032, USA.
Curr Psychiatry Rep. 2017 Jun;19(6):31. doi: 10.1007/s11920-017-0781-y.
The rising suicide rate in the USA will not be reversed without improved risk assessment and prevention practices. To date, the best method for clinicians to assess a patient's risk for suicide is screening for past suicide attempts in the patient and their family. However, neuroimaging, genomic, and biochemical studies have generated a body of findings that allow description of an initial heuristic biological model for suicidal behavior that may have predictive value.
We review studies from the past 3 years examining potential biological predictors of suicide attempt behavior. We divide findings into two major categories: (1) structural and functional brain imaging findings and (2) biochemical and genomic findings encompassing several systems, including major neurotransmitters (serotonin, catecholamines, GABA, and glutamate), the hypothalamic pituitary adrenal (HPA) axis, the inflammasome, lipids, and neuroplasticity. The biomarkers that appear promising for assessing suicide risk in clinical settings include indices of serotonergic function, inflammation, neuronal plasticity, and lipids.
如果不改进风险评估和预防措施，美国不断上升的自杀率将无法得到扭转。迄今为止，临床医生评估患者自杀风险的最佳方法是筛查患者及其家族既往的自杀未遂情况。然而，神经影像学、基因组学和生物化学研究已经产生了一系列研究结果，这些结果使得我们能够描述一个可能具有预测价值的自杀行为初步启发式生物学模型。
我们回顾了过去3年中研究自杀未遂行为潜在生物学预测因素的研究。我们将研究结果分为两大类：（1）脑结构和功能成像结果；（2）生物化学和基因组学结果，涵盖多个系统，包括主要神经递质（血清素、儿茶酚胺、γ-氨基丁酸和谷氨酸）、下丘脑-垂体-肾上腺（HPA）轴、炎性小体、脂质和神经可塑性。在临床环境中，对于评估自杀风险似乎有前景的生物标志物包括血清素能功能、炎症、神经元可塑性和脂质的指标。
