ADVANCES IN PSYCHIATRY IN 2012 

Minerva Psichiatrica 2012 March;53(1):61-78

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Advances in the neuropsychobiology of suicide

Cáceda R., Strassnig M. T., Nemeroff C. B.

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

Approximately one million people worldwide die from suicide every year. Particularly vulnerable groups are active military, adolescents, the elderly and the chronically mentally ill. Suicide prevalence rates vary in different countries, socioeconomic and age groups. More than 90% of suicides are in individuals with a diagnosable psychiatric disorder. Practically all of the major psychiatric disorders are associated with an increased risk for suicide, but depression is responsible for more than half of the cases. Clinical observation, epidemiological studies, psychological autopsies, and neuroscience including genetics, neurochemistry and brain imaging have yielded important findings that have contributed to our increased understanding of suicide. Several biological factors have been linked to suicide risk, including decreased serotonergic neurotransmission, particularly in the ventral prefrontal cortex. Deficits in ventromedial prefrontal cortex function are associated with impulsivity and impaired decision making. A burgeoning database suggests that other biogenic amines and the hypothalamic-pituitary-adrenal (HPA) axis also have a central role in suicide diathesis. Cognitive and psychological factors for high suicide risk include hopelessness, psychological pain, impulsivity, poor problem solving skills, perfectionism, and poor social support. Despite this concatenation of advances, it remains virtually impossible to predict the precise suicide risk for individual patients. Further research exploring neuropsychobiological predictive factors able to inform clinical practice is necessary in order to develop an effective suicide prevention strategy.