Future Suicide Attempt and Responses to Serotonergic Challenge
Future Suicide Attempt and Responses to Serotonergic Challenge
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DOI：
10.1038/npp.2008.28
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发表时间：
2010-04-01
影响因子：
7.6
通讯作者：
Mann, J. John
中科院分区：
文献类型：
--
作者：
Keilp, John G.;Oquendo, Maria A.;Mann, J. John
在重度抑郁症和自杀行为中发现对多巴胺能药物的神经激素反应迟钝，但尚未有关于其与后来自杀企图关系的前瞻性研究。在这项研究中，健康志愿者和抑郁症患者在基线时给予芬氟拉明（FEN）和安慰剂激发试验，然后随访2年。7例受试者在随访期内有自杀企图。健康志愿者、抑郁的非自杀者、抑郁的过去自杀者和抑郁的未来自杀者在血浆催乳素和皮质醇反应以及在基线和每个挑战测试日结束时评估的情绪（情绪状态概况; POMS）和行为测量方面进行了比较。与非患者相比，过去和未来的患者对FEN的总催乳素输出（曲线下面积）较低。与其他组相比，未来的志愿者的皮质醇反应较低。所有受试者组均报告接受FEN后POMS疲劳子量表评分降低，手指敲击率增加。抑郁的受试者报告POMS总分、抑郁和紧张/焦虑评分显著下降，但未来的受试者则没有，显示出轻微的平均增加。研究后3个月和1年，较低的皮质醇反应与更大的自杀意念相关。Logistic回归分析显示，皮质醇反应迟钝、FEN后情绪恶化、年龄较小可预测大多数病例（4/7）日后的自杀企图。结果表明，钝皮质醇和不利的急性情绪反应，以肾上腺素能的挑战，在这些药物的一般激活作用的背景下，可能是后来的自杀企图的危险因素。Neuropsychopharmacology（2010）35，1063-1072; doi：10.1038/npp.2008.28; 2008年3月19日在线发表
Blunted neurohormonal responses to serotonergic agents are found in major depression and suicidal behavior, but there have been no prospective studies of their relationship to later suicide attempt. In this study, healthy volunteers and depressed subjects were administered a fenfluramine (FEN) and placebo challenge test at baseline and then followed for 2 years. Seven subjects made suicide attempts within the follow-up period. Healthy volunteers, depressed non-attempters, depressed past suicide attempters, and depressed future attempters were compared on plasma prolactin and cortisol responses, as well as on mood (Profile of Mood States; POMS) and behavioral measures that were assessed at baseline and at the end of each challenge testing day. Both past and future attempters had lower total prolactin output (area under the curve) in response to FEN relative to non-patients. Future attempters had lower cortisol response relative to all other groups. All subject groups reported a decrease in POMS Fatigue subscale score and increase in finger tapping rate after receiving FEN. Depressed subjects reported a significant decline in POMS Total, Depression, and Tension/Anxiety scores, but future attempters' did not, showing a slight mean increase. Lower cortisol response correlated with greater suicidal ideation 3 months and 1 year post-study. Logistic regression revealed that blunting of cortisol response and worsening of mood after FEN, and younger age could be used to predict later suicide attempt in the majority of cases (4/7). Results suggest that blunted cortisol and unfavorable acute mood response to serotonergic challenge, in the context of the general activating effects of these drugs, may be a risk factor for later suicide attempt. Neuropsychopharmacology (2010) 35, 1063-1072; doi: 10.1038/npp.2008.28; published online 19 March 2008