Academic journal article Indian Journal of Psychiatry

Serum Cholesterol and Suicide in First Episode Psychosis: A Preliminary Study

Academic journal article Indian Journal of Psychiatry

Serum Cholesterol and Suicide in First Episode Psychosis: A Preliminary Study

Article excerpt

Byline: Amresh. Shrivastava, Megan. Johnston, Robbie. Campbell, Avinash. De Sousa, Nilesh. Shah

Background: Low levels of cholesterol have been described in suicide behavior including among those individuals who have an increased tendency for impulsivity. Violent suicide attempters show significantly lower cholesterol levels than nonviolent suicide attempters. The suicide rate is particularly high in the prodromal and early phase of schizophrenia. It is unclear if there is a psychopathological relationship between early psychosis, suicide, and cholesterol levels. The present study examines levels of cholesterol and suicide behavior in a cohort of early psychosis. Methodology: Sixty admitted patients with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of nonaffective schizophrenia spectrum disorder (early psychosis) were assessed in a naturalistic cross-sectional, cohort study. Psychopathology was assessed with the Positive and Negative Symptom Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale, and Scale for Impact of Suicidality-Management, Assessment and Planning of Care (SIS-MAP). Serum levels of cholesterol were estimated in the cohort as well. The findings were analyzed for a clinical correlation of cholesterol levels, suicidal attempters, and psychopathology. Results: Out of 60 patients, 13 patients had a suicide attempt in the recent past. No serum cholesterol abnormality (3.7 [+ or -] 1.2 mmol/L) was observed in patients as a group and those with low suicidality (SIS-MAP <17, serum cholesterol: 4.1 [+ or -] 1.3 mmol/L). However, low levels of cholesterol were observed in a subgroup with severe suicidality (SIS-MAP >33; serum cholesterol: 3.5 [+ or -] 1.4 mmol/L). Females with moderate suicidality showed statistically significant lower cholesterol levels than males (P = 0.047). Conclusions: The study suggests lower levels of cholesterol in patients of psychosis with severe suicidal thoughts and depression in early psychosis. More research is required in this field to determine the neurochemistry of suicide behavior in psychosis and its significance in the prediction of suicidal behavior.

Introduction

The rate of suicide has been reported to be three times higher in individuals with first-episode psychosis when compared to the general population, and suicide rates are known to high throughout the course of schizophrenia.[1] Suicide rates in patients with psychosis have been documented to be 8.6% before their first visit to a hospital and 5.3% during the 1st year of treatment.[2] Suicidal behavior has been linked to a familial tendency coupled with low frustration tolerance, impulsivity, and poor coping with low social support.[3] Research as early as 35 years ago has linked low serum total cholesterol to 27 suicides in a population of 11,554 as reported by a Canadian study.[4] Epidemiologically, it has been reported that violent suicidal attempts are found to have significantly lower cholesterol levels and higher cortisol levels attributed to probable depressive symptoms and malnutrition.[5] Suicide attempters are not a homogeneous group, and there is a huge intergroup variation in their phenomenology, neurobiology, neurochemistry, and risk factor profile.[6]

Low cholesterol and increased risk of suicide have also been reported in criminal violence, impulsive aggressive behavior, mood disorders, substance abuse, psychosis, and personality disorders.[7] Violent suicide completers also show significantly lower cholesterol and platelet serotonin in the first episode of psychosis in comparison to nonviolent and healthy controls.[8] The neurobiology of suicidal behavior in relation to cholesterol has not been studied sufficiently though a number of studies suggest abnormality in leptin and lipid metabolism linked to suicidal behavior.[9] It remains unclear how low cholesterol in the peripheral system might be related to the brain functions mediating suicidal behavior. …

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