Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY USA; Department of Psychiatry, Columbia University, New York, NY USA.
Department of Molecular Imaging & Neuropathology, New York State Psychiatric Institute, New York, NY USA; Department of Psychiatry, Columbia University, New York, NY USA.
Psychiatry Res. 2019 Oct;280:112486. doi: 10.1016/j.psychres.2019.112486. Epub 2019 Jul 16.
While prominent models of suicidal behavior emphasize the hypothalamic- pituitary-adrenal (HPA) axis dysregulation, studies examining its role have yielded contradictory results. One possible explanation is that suicide attempters are a heterogeneous group and HPA axis dysregulation plays a more important role only in a subset of suicidal individuals. HPA axis dysregulation also plays a role in impulsivity and aggression. We hypothesize subgroups of attempters, based on levels of impulsivity and aggression, will differ in HPA axis dysregulation. We examined baseline cortisol, total cortisol output, and cortisol reactivity in mood disordered suicide attempters (N = 35) and non-attempters (N = 37) during the Trier Social Stress Test. Suicide attempters were divided into four subgroups: low aggression/low impulsivity, high aggression/low impulsivity, low aggression/high impulsivity, and high aggression/high impulsivity. As hypothesized, attempters and non-attempters did not differ in any cortisol measures while stress response differed based on impulsivity/aggression levels in suicide attempters, and when compared to non-attempters. Specifically, attempters with high impulsive aggression had a more pronounced cortisol response compared with other groups. This is the first study to examine the relationship between cortisol response and suicidal behavior in impulsive aggressive subgroups of attempters. These findings may help to identify a stress responsive suicidal subtype of individuals.
虽然自杀行为的突出模型强调下丘脑-垂体-肾上腺（HPA）轴失调，但研究其作用的结果却相互矛盾。一种可能的解释是，自杀未遂者是一个异质群体，HPA 轴失调仅在一部分自杀个体中发挥更重要的作用。HPA 轴失调也在冲动和攻击行为中发挥作用。我们假设，基于冲动和攻击水平的不同，尝试自杀者的亚组在 HPA 轴失调方面存在差异。我们在 Trier 社会应激测试中检查了心境障碍性自杀未遂者（N=35）和非未遂者（N=37）的基线皮质醇、总皮质醇输出和皮质醇反应。自杀未遂者分为四个亚组：低攻击性/低冲动性、高攻击性/低冲动性、低攻击性/高冲动性和高攻击性/高冲动性。正如假设的那样，未遂者和非未遂者在任何皮质醇测量方面均无差异，而应激反应则根据自杀未遂者的冲动/攻击性水平以及与非未遂者的比较而有所不同。具体而言，具有高冲动攻击性的未遂者与其他组相比，皮质醇反应更为明显。这是首次研究冲动性攻击亚组的未遂者的皮质醇反应与自杀行为之间的关系。这些发现可能有助于识别应激反应性的自杀亚型个体。
