PSYCHOBIOLOGICAL PREDICTORS OF SUICIDAL BEHAVIOR IN MDE

MDE 自杀行为的心理生物学预测因素

• 批准号: 2468247
• 负责人: Joseph John Mann
• 金额: $ 19.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-05-01 至 2003-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2468247
• 关键词: antidepressants; behavior disorders; behavior prediction; behavioral /social science research tag; case history; clinical research; human subject; interview; longitudinal human study; major depression; mental disorder diagnosis; personality tests; positron emission tomography; psychobiology; serotonin; suicide; tryptophan

DESCRIPTION (Adapted from applicant's abstract): Most studies of the association of suicide and suicide attempts with "depression" have suffered from methodologic limitations, e.g., retrospective diagnosis, no structured diagnostic interviews, or overly restricted to one or other domain of potential predictor variables. The investigator has implemented the first comprehensive, psychobiological, prospective study of predictors of suicidal behavior in major depression. The study utilizes a unique cohort of 400 patients hospitalized with a Major Depressive Episode (200 past attempters, 200 nonattempters) who are receiving extensive diagnostic, behavioral and biological baseline assessments as part of the NIMH-funded Mental Health Clinical Research Center for the Study of Suicidal Behavior at Columbia University. The investigator is now requesting funding to continue support of the second half of this prospective study. Patients are reassessed for clinical state, life events, treatment and suicidal behavior at 3 months, 12 months and 24 months after discharge. Since determinants of suicidal behavior are derived from multiple domains including psychopathologic, genetic, biologic, psychologic, familial and psychosocial, the development of a general explanatory or predictive model of suicide attempt behavior is dependent on simultaneous assessment of potential risk factors from multiple domains in the same patient population. The testing of such a predictive model for suicidal behavior requires a prospective follow-up study. The investigator proposes a stress-diathesis model which posits that risk factors from both the stress/ trigger domain and from the diathesis/threshold domain are required in suicide attempters. The major hypotheses of the present study are that when a major depression is present, other factors, particularly from the diathesis/ threshold domain are paramount, e.g., characterological traits (such as aggression, impulsivity), and biological measures (CSF 5-HIAA, prolactin response to fenfluramine, serotonin-related gene markers) in distinguishing attempters from nonattempters, both retrospectively and prospectively. A second series of hypotheses is that predictors of high lethality suicide attempts differ from predictors of low lethality attempts. Thus far, the investigator has studied 175 patients at baseline, have tracked approximately 90 percent at three months and 80 percent at two years. Baseline analyses have identified several factors distinguishing attempters and nonattempters including aggression/impulsivity traits, low serotonergic activity, family history of suicidal acts, tryptophan (TPH) hydroxylase genotype, but not objective severity of depression. Future suicide attempts were related to past suicide attempt history, aggression/impulsivity, low serotonergic activity, level of antidepressant treatment and otherwise similar factors to past attempts. An expanded study population will permit comprehensive hypothesis testing and comparison of predictors.

描述（根据申请人的摘要改编）：大多数研究 自杀和自杀企图与“抑郁”的企图遭受了 从方法论的局限性，例如回顾性​​诊断，没有结构化的 诊断访谈，或过度限于一个或另一个领域 潜在的预测变量。 调查人员已经实施了第一个 自杀预测因素的全面，心理生物学，前瞻性研究 大萧条的行为。 该研究利用了400个独特的队列 患者患有重大抑郁发作（过去有200例抑郁症）， 200个非活性）正在接受广泛的诊断，行为和 生物基线评估作为NIMH资助的心理健康的一部分 哥伦比亚自杀行为研究临床研究中心 大学。 研究人员现在要求资金继续支持 这项前瞻性研究的后半部分。 患者重新评估 临床状态，生命事件，治疗和自杀行为3个月，12 出院后的几个月零24个月。 由于自杀的决定因素 行为源自包括精神病学在内的多个领域， 遗传，生物学，心理学，家庭和心理社会的发展 自杀尝试行为的一般解释或预测模型是 依赖于多个的潜在危险因素的同时评估 同一患者人群中的领域。 这种预测性的测试 自杀行为的模型需要一项前瞻性后续研究。 这 研究者提出了一个应力分析模型，该模型认为风险 压力/触发域以及来自 在自杀式预示体中需要透明/阈值结构域。 专业 本研究的假设是，当存在严重抑郁症时， 其他因素，尤其是来自核糖/阈值领域的因素 最重要的，例如特质（例如侵略性，冲动性）， 和生物学措施（CSF 5-HIAA，催乳素对芬氟拉明的反应， 5-羟色胺相关的基因标记）在区分假说和 追溯和前瞻性的非生物。 第二系列 假设是高致死性自杀尝试的预测因素与 低致死性尝试的预测因素。 到目前为止，调查员已经 研究了175例基线患者，在 两年三个月和80％。 基线分析已经确定 区分载体和非生物的几个因素，包括 侵略/冲动性状，低血清素能活性，家族史 自杀行为，色氨酸（TPH）羟化酶基因型，但不是客观的 抑郁的严重程度。 未来的自杀企图与过去有关 自杀尝试历史，侵略性/冲动性，血清素能活性低， 抗抑郁药的水平与过去类似的因素 尝试。 扩大的研究人群将允许全面的假设 预测因子的测试和比较。