XI Congresso della Società Italiana di Psicopatologia Psichiatria ...

Reference
1 Isacsson G. Suicide prevention – a medical breakthrough? Acta
Psychiatr Scand 2000;102:113-7.
2 Olfson M, Shaffer D, Marcus SC, Greenberg T. Relationship between
antidepressant medication treatment and suicide in adolescents.
Arch Gen Psychiatry 2003;60:978-82.
3 Isacsson G, Holmgren P, Ahlner J. Selective serotonin reuptake
inhibitor antidepressants and the risk of suicide: a controlled
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2005;111:286-90.
Neurobiologic basis for suicide:
new findings
SIMPOSI TEMATICI
J.J. Mann
Department of Psychiatry, Columbia University; Department
of Neuroscience, NYS Psychiatric Institute, New York
Studies of the neurobiologic correlates of suicide have
largely focused on postmortem brain analyses. An initial
breakthrough set of studies employed autoradiography to
map receptor changes throughout the brain in suicides.
These mapping studies were able to show that serotonin
receptor changes associated with suicide, in contrast to
mood disorders, were localized to the ventral prefrontal
cortex.
This linked deficient serotonergic input to decision making
and impulsiveness which involves the ventral prefrontal
cortex.
More recently, studies have examined the serotonin neuron
cell bodies in the raphe nuclei in the brainstem. Those
studies have shown that there are more serotonin neurons
and that both the protein and messenger RNA for tryptophan
hydroxylase 2, the rate-limiting biosynthetic enzyme
for serotonin, are higher in the raphe nuclei of suicides.
Conversely, 5-HT 1A autoreceptor binding and message are
lower. These changes are consistent with upregulation of
serotonin neuron function and therefore potential homeostatic
responses to low serotonin release.
These brainstem changes may be due to suicide or may be
due to mood disorders, which frequently underlies suicidal
behavior. That question remains to be resolved.
Other changes that have been observed in suicide victims
involve alterations in noradrenergic and dopaminergic
function as well as in second messenger responses in the
cortex. Blunted second messenger responses in relation to
the 5-HT 1A and 5-HT 2A receptor populations are present
and may represent a second abnormality at the level of
signal transduction related to suicide.
Again, these studies only partly resolve the question of
whether these changes are related to depression or mood
disorders, or with suicide. These findings in monoamine
systems may also be associated with functional variants in
candidate genes and represent developmental effects.
There will be some discussion of those associations with
genes and childhood adversity.
Trends in suicide rates: an international
perspective
L. Tondo * ** *** , R.J. Baldessarini **
* Dipartimento Psicologia, Università di Cagliari; ** Department
of Psychiatry, Harvard Medical School,
“McLean” Division of Massachusetts General Hospital;
*** Centro “Bini”, Cagliari
Introduction: annual suicide rates per 100,000 population
vary widely among countries, probably due in part to dissimilar
case-ascertainment and reporting procedures. Nevertheless,
even among countries expected to have relatively
reliable data, recent suicide rates vary enormously, from
over 29 in Hungary to as low as 3.5 in Greece. Suicide rates
also show notable secular fluctuations within countries.
However, average international rates have been quite stable
over the last 50 years, at approximately 13.0. Suicide has
been associated with psychiatric disorders in about 90% of
cases evaluated postmortem, and depressive or mixed dysphoric-agitated
mood states account for about 80% of cases.
It is surprising, therefore, that during the last half-century
major changes in the level of clinical and social awareness
of depressive illness as well as advances in pharmacological
and psychosocial treatments for mood and other psychiatric
disorders appear to have contributed little to decrease the incidence
of suicide. We now report on findings pertaining to
international trends in suicide rates.
Methods: we collected data from WHO (www.who.org) on
national suicide rates from 24 representative countries, providing
rates for men and women every five-years from the
1950s to 2000, and calculated percent change from 1950 or
the earliest reported year. Encouraged by studies suggesting
an association of decreasing suicide rates with increasing
use of antidepressants in recent decades in some Western
countries, we hypothesized that widespread acceptance of
the tricyclic antidepressants (TCAs) in the 1970s, and their
replacement by the serotonin-reuptake inhibitors (SRIs) and
other modern antidepressants in the 1990s might be reflected
in changes in suicide rates as either universal or regional
trends.
Results: changes in international suicide rates over the past
half-century range from an 80% decrease in Portugal to an
80% increase in Ireland (likely an artifact of increased report
after decriminalization of suicide there in 1991), with a minor,
highly variable average increase of 3.32 ± 0.1% over the
half-century. Changes between 1990 and 2000 range from a
decrease of 73% in Portugal to an increase of 35% in Japan,
but yield a statistically significant average decrease of 14.9%
± 25.4, with marked differences among world regions.
Conclusions: these findings suggest that average international
suicide rates have been quite stable over the last 50
years but with striking variations between, and substantial
shifts within countries. There has been a tendency to attribute
moderate reported decreases in suicide rates, particularly
among younger age groups in Northern Europe and
North America, to greater acceptance of relatively safe modern
antidepressants over the past decade. However, such
trends often were identifiable well before widespread clinical
use of SSRIs and other modern antidepressants. Moreover,
such ecological analyses of population trends should
be considered with great caution since they may not reflect
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