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Objective: Patients with both major depression and personality disorders have a high risk of suicidal behavior. Lithium is meant to have anti-suicidal properties in patients with affective disorders. The anti-suicidal effect of lithium in patients with affective disorders and comorbid personality disorders has not been investigated yet., Methods: A post-hoc analysis of a subsample of patients with depression and comorbid personality disorder (PD) and a recent suicide attempt (n = 19) from the prospective, placebo-controlled lithium intervention study (N = 167), was conducted., Results: Three patients in the lithium group (n = 8) and two patients in the placebo group (n = 11) presented a suicide attempt throughout the course of the study. No differences related to suicidal behavior could be detected between the placebo group and the group with lithium intervention., Conclusions: On the basis of the small sample size, among patients with comorbid PD, lithium does not seem to have an effect on suicidal behavior in contrast to patients with affective disorders without comorbid PD.

Objective: Evidence based on controlled studies is still limited for treatment strategies that prevent recurrence of suicide attempts. Findings from observational as well as meta-analytic studies strongly suggest that lithium may have suicide-protective properties., Method: Patients with a recent suicide attempt in the context of an affective spectrum disorder (n = 167) were treated with either lithium or placebo during a 12-month period., Results: Survival analysis showed no significant difference of suicidal acts between lithium and placebo-treated individuals (adjusted hazard ratio 0.517; 95% CI 0.18-1.43). However, post hoc analysis revealed that all completed suicides had occurred in the placebo group accounting for a significant difference in incidence rates (P = 0.049)., Conclusion: Results indicate that lithium treatment might be effective in reducing the risk of completed suicide in adult patients with affective disorders. Our findings contribute to the growing body of evidence suggesting a specific antisuicidal effect of lithium.

Objectives: The risk of suicidal behavior is substantially elevated in major affective disorders (AD). In bipolar disorder (BD), as many as 15% of patients may commit suicide and family history of suicide is recognized as one of the most important risk factors. Lithium reduces the rates of suicidal behavior in BD, especially in patients who achieve full mood stabilization. Yet even patients who continue experiencing mood episodes do benefit from anti-suicidal properties of lithium. These observations raise questions about the nature of the relationship between the neurobiological mechanisms of BD and suicide, namely whether they are shared or independent., Methods: We studied the distribution of suicides and suicide attempts in 539 subjects from 78 families of probands with major AD, all responders to lithium prophylaxis. A Cox proportional hazard regression model was used to assess the contribution of several independent variables to the risks of AD, BD, and suicidal behavior., Results: The lifetime prevalence of BD was significantly greater among first-degree relatives of suicide than non-suicide probands (22% versus 11%) and the prevalence of BD in families was associated with an increased risk of developing mood disorder and subsequently committing or attempting suicide (p = 0.003). Families fell into 1 of 3 groups, corresponding to a low (<0.1%), intermediate (17.8%), and high (87.8%) risk for suicide in affectively ill subjects., Conclusions: Suicidal behavior is distributed unevenly in families of probands with BD, aggregating in a subset of families. Our results also suggest that partially overlapping sets of genetic factors may underlie BD and suicide.

Background: A robust association between "suicidality" and deficits of the serotoninergic neurotransmission has been claimed in the past. However, many studies having investigated the relationship between suicidality and peripheral indicators of serotoninergic neurotransmission suffer from considering only one or a very small number of potentially useful serotoninergic parameters, whereas a synoptic multidimensional approach appears to be more appropriate. Furthermore, the psychiatric context within which suicidal behaviour occurs should be considered when interpreting biochemical findings of patients with suicidal ideation and suicide attempts., Methods: In the present study 5 peripheral serotonergic markers, (platelet 5HT concentration, 5HT uptake activity, 5HT(2A) receptor binding characteristics, MAO-B activity and tryptophan concentration in plasma) were assessed simultaneously. Of the 60 acutely suicidal inpatients (ICD-10: F43.xx, n = 52; F31/32/33, n = 8), 45 were suicide attempters. Data of 28 nonsuicidal patients with major depression (F31, n = 4; F32, n = 14; F33, n = 10) and 123 healthy volunteers represented the control groups., Results: Mean platelet 5HT concentration was significantly lower in suicidal inpatients when compared to nonsuicidal depressed patients, but did not differ from the figure in healthy subjects. Nonsuicidal depressed patients showed significantly higher mean platelet-5HT concentration than healthy controls. Mean V(max) of 5HT uptake in washed platelets, but not in platelet-rich plasma, was significantly higher in suicidal patients than in healthy controls, not, however, when compared to nonsuicidal depressed patients. Mean K(D) for the platelet 5HT(2A) receptor and MAO-B activity were significantly lower in suicidal patients as compared to nonsuicidal depressed patients and healthy controls. The observed differences in peripheral serotonergic markers between groups are partially due to a significant gender effect. A lower MAO-B activity was observed only in suicidal females, while the higher V(max) of 5HT uptake in washed platelets of suicidal patients was due to suicidal males., Conclusions: In view of conflicting observations made by other authors and the present findings on suicidal patients with adjustment disorder it remains doubtful whether and if so to which extent platelet studies can provide valid information on serotonergic mechanisms related to suicidal behaviour.

This article examines the diagnostic status of suicidal ideation with and without additional signs of defined or subthreshold mental disorders. Data from the World Health Organization (WHO) study on Psychological Problems in General Health Care (PPGHC) show that 8.8% of all general practice patients report that they recently had a wish to be dead. Among patients with acute depressive episodes, the rate is 34.5%, as compared with 1.3% in persons without any sign of mental disorder. Rates of suicidal ideation in persons with subthreshold disorders (10.4%) are similar to the rate in persons with other, nondepressed forms of mental disorders (12.9%). Still, 30.1% of all persons with suicidal ideation do not have a defined mental disorder, and 21.5% do not even have subthreshold disorders. But in these persons also, suicidal ideation is associated with an increased rate of depressive complaints. Suicidal ideation therefore, in any case, can be seen as an indicator of mental problems. But it seems impossible to lower the thresholds of defined mental disorders so that all forms of suicidal ideation will be covered. Instead, suicidal thoughts must be regarded as a symptom with the status of a disorder itself which should be handled as a comorbid condition if other mental disorders co-occur.

Biological findings such as low 5-HIAA levels in cerebrospinal fluid (CSF) in suicidal patients compared to non-suicidal patients independent of the type of psychiatric disorder indicate a broad basis for suicidality. It is therefore important to ask whether a suicidality syndrome can be delineated on a phenomenological level, and whether it is independent of specific major psychiatric disorders which are otherwise considered to be aetiologically different. This paper reports on a study of 2383 schizophrenic and 1920 depressive unselected patients with and without suicidality. They were assessed during the first 24 h after admission to a psychiatric in-patient facility using a comprehensive psychopathological assessment (AMDP system). Using multiple variance analysis and logistic regression analysis based on single symptoms, for both suicidal and non-suicidal patients it was shown that a suicidality syndrome independent of the underlying illness can be delineated. In schizophrenia as well as in major affective disorders it was found that hopelessness, ruminative thinking, social withdrawal and lack of activity are core symptoms of this suicidal syndrome. The finding of a suicidality syndrome, not associated with a specific major affective disorder, indicates the need to identify this syndrome, which should be seen as an independent dimension and diagnosed separately, and not regarded merely as a secondary symptom of major psychiatric disorders, particularly affective disorders.

In this investigation the frequency and clinical importance of suicidal behavior in patients with a primary diagnosis of personality disorder was studied. The sample was drawn from a group of over 8000 psychiatric inpatients admitted to a university psychiatric hospital. Only patients with a primary diagnosis of personality disorder were included. In the subgroup of 226 patients with this diagnosis, it was found that the rate of suicidality was almost as great as that of patients with a primary diagnosis of major affective disorder (39% as opposed to 41%), despite the absence in all but 3% of these patients of an additional diagnosis of affective disorder. Further, this figure was considerably higher than that for all psychiatric inpatients (24%). Suicidal patients had more suicide attempts in their history and had a more serious depressive syndrome, despite the fact that only 3% fulfilled the criteria for major affective disorder. The conclusion which can be drawn is that a high degree of suicidality should not be regarded as exclusively linked to a primary diagnosis of major affective disorder.

One of the strongest predictors of suicide is a suicide attempt in the history of the patient. The question, however, is to what extent age and duration of the illness affects the risk of a suicide attempt. In this study, we examined the course of 310 patients with primary affective disorders before lithium prophylaxis and compared the clinical data of those with and without suicide attempts in their history. In a subgroup of 98 patients with suicide attempts, measures for both suicide attempts and inpatient episodes were investigated. Comparing patients with suicide attempts and those without, we found no difference between duration of illness and number of previous episodes between the two groups. However, those with a suicide attempt in their history had an earlier onset of the illness. In the group of 98 suicide attempters, we found no significant correlation between age and rates for both episodes and suicide attempts, which indicates that these rates were not declining as the illness progressed and the patient aged. Dividing the sample into three different age groups, episode rates and rates of attempted suicide were found to be positively correlated in all age groups, again indicating that as long as episodes occur, the suicide risk does not decline. The results are not in favor of findings which suggest that the risk of attempting suicide might manifest itself primarily in the early course of the illness or that suicide attempts in the early course of illness provide a 'cathartic effect' which leads to a lower risk in the later course of the illness. Rather, the findings support the view that the risk of suicide attempts in recurrent affective disorders is unchanged in all age groups and throughout all stages of untreated illness.

Early recognition of suicidal behavior is of extreme importance for avoidance of this cause of death. The risk of suicide attempts is particularly high in psychiatric illness, and among hospital in-patients especially in those with depression. Thus, the risk of suicide should be estimated in the first interview after admission to a psychiatric hospital. Our study analysed the routine documentation of such interviews on admission to the Psychiatrische Klinik der Freien Universität in Berlin: 41% of all depressive patients were suicidal. Suicidal and non-suicidal depressive patients could be differentiated by the following traits: suicidal patients were younger, had been younger at the initial onset of depressive illness, had made more suicide attempts in the past, and had a greater number of relatives who had committed suicide or made suicide attempts. They were more often single or divorced, and had fewer children of their own. Their psychopathology was characterized by a more strongly developed syndrome of depression, hostility and apathy. These findings point to a pattern of characteristics that are linked with suicidal behavior, which can be used to estimate the risk of suicide right at the beginning of a stay in hospital.