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CSF 5-HIAA and DST non-suppression--orthogonal biologic risk factors for suicide in male mood disorder inpatients.

Abstract
Two biomarkers of suicide risk; non-suppression in the dexamethasone suppression test (DST) and low 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have been reported to be predictors of suicide in mood disorders. The interrelation of the two systems seems to be different in suicide attempters compared with depressed inpatients who have not made a suicide attempt, indicating that the two biomarkers may be seen as independent. This investigation examined the interrelation of low CSF 5-HIAA and DST non-suppression in suicide victims with mood disorder. Fifty-eight mood disorder inpatients not receiving any treatment with antidepressants underwent lumbar puncture and the DST. Plasma cortisol levels at 8:00 a.m., 4:00 p.m. and 11:00 p.m. were analysed in relation to CSF 5-HIAA. All patients were followed up for causes of death and suicides were verified with death certificates. During follow-up (mean 21 years), 11 (19%) patients had committed suicide. In male suicide victims (n=6), the serum cortisol level at 4:00 p.m. showed a significant positive correlation with CSF 5-HIAA. Low CSF 5-HIAA predicted all early suicides (within 1 year), whereas all males who committed suicide after 1 year were DST non-suppressors. In female suicide victims (n=5), the post-DST serum cortisol did not correlate with CSF 5-HIAA. Low CSF 5-HIAA and DST non-suppression are orthogonal biologic risk factors for suicide in male mood disorder inpatients. CSF 5-HIAA is associated with short-term suicide risk; dysregulation of the hypothalamic-pituitary-adrenal axis seems to be a long-term suicide predictor.
AuthorsJussi Jokinen, Anna-Lena Nordström, Peter Nordström
JournalPsychiatry research (Psychiatry Res) Vol. 165 Issue 1-2 Pg. 96-102 (Jan 30 2009) ISSN: 0165-1781 [Print] Ireland
PMID19062105 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Biomarkers
  • Hydroxyindoleacetic Acid
  • Dexamethasone
  • Hydrocortisone
Topics
  • Adult
  • Biomarkers
  • Bipolar Disorder (mortality, physiopathology, psychology)
  • Cause of Death
  • Cohort Studies
  • Cross-Sectional Studies
  • Depressive Disorder, Major (mortality, physiopathology, psychology)
  • Dexamethasone
  • Dysthymic Disorder (mortality, physiopathology, psychology)
  • Female
  • Follow-Up Studies
  • Humans
  • Hydrocortisone (blood)
  • Hydroxyindoleacetic Acid (cerebrospinal fluid)
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Sex Factors
  • Suicide (psychology, statistics & numerical data)
  • Sweden

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