自杀未遂抑郁症患者赛乐特治疗中n-3PUFA的辅助效果观察
摘要
目的观察n-3不饱和脂肪酸(n-3PUFA)辅助赛乐特治疗自杀未遂的抑郁症患者的临床效果。
对象和方法本研究收集2005年8月至2006年12月在大连市金州区中心医院和吉林市精神病医院就诊的39例自杀未遂的抑郁症患者为研究对象。采取随机双盲的方法,应用n-3PUFA对39例自杀未遂的抑郁症患者进行辅助治疗,疗程为3个月,其中21例为n-3PUFA组,18例为安慰剂组。所有患者都接受了标准抗抑郁药物治疗(赛乐特20mg/d)。所有病例都在治疗前、治疗1.5个月和治疗3个月的时点上,抽取5ml静脉血,进行红细胞膜脂肪酸水平测定,同时采用汉密尔顿抑郁量表,贝克抑郁自评问卷及贝克自杀意图量表进行心理评估。采用SPSS12.0软件包,进行了t检验、χ2检验、方差分析和Pearson相关分析。
结果1. 39例自杀未遂抑郁症患者抑郁得分与脂肪酸的相关分析。汉密尔顿抑郁量表得分与AA和AA/EPA呈正相关(P<0.05)。2.治疗前、治疗1.5个月和治疗3个月三时点,n-3PUFA组和安慰剂组比较。(1)抑郁状况:两组在治疗前后的三个时点汉密尔顿抑郁量表和贝克抑郁自评问卷得分之间差异无统计学意义(P>0.05)。(2)自杀意念情况:两组在治疗前后的三个时点贝克自杀意图量表得分之间差异无统计学意义(P>0.05)。(3)红细胞膜脂肪酸水平:治疗前,两组之间差异无统计学意义(P>0.05);治疗1.5个月,n-3PUFA组与安慰剂组在20:5 n-3(EPA), 22:6 n-3(DHA), n-3%和n-6/n-3上的差异具有统计学意义(P<0.05);治疗3个月,n-3PUFA组和安慰剂组在20:5 n-3(EPA), 22:6 n-3(DHA), n-3%和n-6/n-3的差异具有统计学意义(P<0.05)。3.治疗前后各种指标自身比较。(1)抑郁状况在汉密尔顿抑郁量表和贝克抑郁自评问卷得分上,n-3PUFA组及安慰剂组在治疗前、治疗1.5个月和治疗3个月三个时间点自身比较,差异均具有统计学意义(P<0.05)。(2)红细胞膜脂肪酸水平n-3PUFA组治疗前后红细胞膜脂肪酸水平的自身比较,三组之间在20:5 n-3(EPA), 22:5 (n=3), 22:6 n-3(DHA), n-3%和n-6/n-3上的差异具有统计学意义(P<0.05);安慰剂组治疗前后红细胞膜脂肪酸水平的自身比较,三组之间的差异无统计学意义(P>0.05)。
结论
1. 39例自杀未遂抑郁症患者抑郁得分越高,AA和AA/EPA越高。
2. n-3PUFA组和安慰剂组抑郁症状改善是同等的。
3. n-3PUFA组和安慰剂组自杀意念降低程度是同等的。
4.自杀未遂抑郁症患者赛乐特治疗中,n-3PUFA没有辅助作用。
Objective: To find supplementary effects of n-3 polyunsaturated fatty acids to Paroxetine for depression of suicide attempters.
Objects and Methods:We had drawn out 39 attempted suicide patients who suffering from depression from Dalian Jinzhou District Central Hospital and Jilin psychiatric hospital during August 2005 to December 2006. 21 cases were given n-3PUFA to intervention by 3 months with random and double blind method, and 18 cases were served as control. During the intervention period, 39 attempted suicide patients had received fixed dose of antidepressant (Paroxetine 20mg/d). In the same time, HRSD (Hamilton Depression Rating Scale), BDI (Beck’s depression inventory) and SIS (the Suicide Intent Scale) were evaluated respectively at baseline, then 1.5 and 3 months. Blood samples were collected from 39 attempted suicide patients at above 3 time points to fatty acid analysis.
Data was input in the computer, SPSS12.0 software was used to t test, Chi-square, one-way ANOVA and Pearson correlation.
Results: Firstly, how correlation existed between the depressed scores of 39 suicide attempters and the fatty acids level. Scores of HRSD positively correlated with AA, AA/EPA. Secondly, Comparison between n-3 PUFA intervention group and control group at 3 time points.①Depressive state There were no significant differences between n-3 PUFA intervention group and control group on scores of HRSD and BDI at 3 time points (P>0.05).②Suicide ideation There were no significant differences between n-3 PUFA intervention group and control group on scores of SIS at 3 time points(P>0.05).③PUFA levels of erythrocyte membrane There were no significant differences between n-3 PUFA intervention and control group at baseline (P>0.05); There were significant differences between n-3 PUFA intervention group and control group on 20:5 n-3(EPA), 22:6n-3(DHA), n-3% and n-6/n-3 at 1.5 and 3 months point (P<0.05). Thirdly, Self- comparison among the 3 points of time before and after intervention.①Depressive state Some significant differences were found on scores of HRSD and BDI in any one of n-3 PUFA intervention group and control group to self-comparison among 3 points of time (P<0.05).②PUFA levels of erythrocyte membrane In n-3 PUFA intervention group, some significant differences existed in 20:5 n-3(EPA), 22:5 (n=3), 22:6n-3(DHA), n-3% and n-6/n-3 at self-comparison among 3 time points (P<0.05); In the control group, no significant differences were found on PUFA levels of erythrocyte membrane at self-comparison of 3 time points (P>0.05).
Conclusions:①Depressed scores of 39 suicide attempters with depression are higher, AA and AA/EPA are higher.②Improving depression is equal between n-3 PUFA intervention group and control group.③Reducing suicide ideation is equal between n-3 PUFA intervention group and control group.④There are no supplementary effects of n-3 PUFA to Paroxetine for depression of suicide attempters.
对象和方法本研究收集2005年8月至2006年12月在大连市金州区中心医院和吉林市精神病医院就诊的39例自杀未遂的抑郁症患者为研究对象。采取随机双盲的方法,应用n-3PUFA对39例自杀未遂的抑郁症患者进行辅助治疗,疗程为3个月,其中21例为n-3PUFA组,18例为安慰剂组。所有患者都接受了标准抗抑郁药物治疗(赛乐特20mg/d)。所有病例都在治疗前、治疗1.5个月和治疗3个月的时点上,抽取5ml静脉血,进行红细胞膜脂肪酸水平测定,同时采用汉密尔顿抑郁量表,贝克抑郁自评问卷及贝克自杀意图量表进行心理评估。采用SPSS12.0软件包,进行了t检验、χ2检验、方差分析和Pearson相关分析。
结果1. 39例自杀未遂抑郁症患者抑郁得分与脂肪酸的相关分析。汉密尔顿抑郁量表得分与AA和AA/EPA呈正相关(P<0.05)。2.治疗前、治疗1.5个月和治疗3个月三时点,n-3PUFA组和安慰剂组比较。(1)抑郁状况:两组在治疗前后的三个时点汉密尔顿抑郁量表和贝克抑郁自评问卷得分之间差异无统计学意义(P>0.05)。(2)自杀意念情况:两组在治疗前后的三个时点贝克自杀意图量表得分之间差异无统计学意义(P>0.05)。(3)红细胞膜脂肪酸水平:治疗前,两组之间差异无统计学意义(P>0.05);治疗1.5个月,n-3PUFA组与安慰剂组在20:5 n-3(EPA), 22:6 n-3(DHA), n-3%和n-6/n-3上的差异具有统计学意义(P<0.05);治疗3个月,n-3PUFA组和安慰剂组在20:5 n-3(EPA), 22:6 n-3(DHA), n-3%和n-6/n-3的差异具有统计学意义(P<0.05)。3.治疗前后各种指标自身比较。(1)抑郁状况在汉密尔顿抑郁量表和贝克抑郁自评问卷得分上,n-3PUFA组及安慰剂组在治疗前、治疗1.5个月和治疗3个月三个时间点自身比较,差异均具有统计学意义(P<0.05)。(2)红细胞膜脂肪酸水平n-3PUFA组治疗前后红细胞膜脂肪酸水平的自身比较,三组之间在20:5 n-3(EPA), 22:5 (n=3), 22:6 n-3(DHA), n-3%和n-6/n-3上的差异具有统计学意义(P<0.05);安慰剂组治疗前后红细胞膜脂肪酸水平的自身比较,三组之间的差异无统计学意义(P>0.05)。
结论
1. 39例自杀未遂抑郁症患者抑郁得分越高,AA和AA/EPA越高。
2. n-3PUFA组和安慰剂组抑郁症状改善是同等的。
3. n-3PUFA组和安慰剂组自杀意念降低程度是同等的。
4.自杀未遂抑郁症患者赛乐特治疗中,n-3PUFA没有辅助作用。
Objective: To find supplementary effects of n-3 polyunsaturated fatty acids to Paroxetine for depression of suicide attempters.
Objects and Methods:We had drawn out 39 attempted suicide patients who suffering from depression from Dalian Jinzhou District Central Hospital and Jilin psychiatric hospital during August 2005 to December 2006. 21 cases were given n-3PUFA to intervention by 3 months with random and double blind method, and 18 cases were served as control. During the intervention period, 39 attempted suicide patients had received fixed dose of antidepressant (Paroxetine 20mg/d). In the same time, HRSD (Hamilton Depression Rating Scale), BDI (Beck’s depression inventory) and SIS (the Suicide Intent Scale) were evaluated respectively at baseline, then 1.5 and 3 months. Blood samples were collected from 39 attempted suicide patients at above 3 time points to fatty acid analysis.
Data was input in the computer, SPSS12.0 software was used to t test, Chi-square, one-way ANOVA and Pearson correlation.
Results: Firstly, how correlation existed between the depressed scores of 39 suicide attempters and the fatty acids level. Scores of HRSD positively correlated with AA, AA/EPA. Secondly, Comparison between n-3 PUFA intervention group and control group at 3 time points.①Depressive state There were no significant differences between n-3 PUFA intervention group and control group on scores of HRSD and BDI at 3 time points (P>0.05).②Suicide ideation There were no significant differences between n-3 PUFA intervention group and control group on scores of SIS at 3 time points(P>0.05).③PUFA levels of erythrocyte membrane There were no significant differences between n-3 PUFA intervention and control group at baseline (P>0.05); There were significant differences between n-3 PUFA intervention group and control group on 20:5 n-3(EPA), 22:6n-3(DHA), n-3% and n-6/n-3 at 1.5 and 3 months point (P<0.05). Thirdly, Self- comparison among the 3 points of time before and after intervention.①Depressive state Some significant differences were found on scores of HRSD and BDI in any one of n-3 PUFA intervention group and control group to self-comparison among 3 points of time (P<0.05).②PUFA levels of erythrocyte membrane In n-3 PUFA intervention group, some significant differences existed in 20:5 n-3(EPA), 22:5 (n=3), 22:6n-3(DHA), n-3% and n-6/n-3 at self-comparison among 3 time points (P<0.05); In the control group, no significant differences were found on PUFA levels of erythrocyte membrane at self-comparison of 3 time points (P>0.05).
Conclusions:①Depressed scores of 39 suicide attempters with depression are higher, AA and AA/EPA are higher.②Improving depression is equal between n-3 PUFA intervention group and control group.③Reducing suicide ideation is equal between n-3 PUFA intervention group and control group.④There are no supplementary effects of n-3 PUFA to Paroxetine for depression of suicide attempters.
引文
1. Gibbons RD,Brown CH,Hur K,et al. Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets. Am J Psychiatry,2007, 164(7):1044-1049. PMID:17606656
2. Nakagawa A,Grunebaum MF,Ellis SP,et al. Association of suicide and anti-depressant prescription rates in Japan, 1999-2003. Clin Psychiatry,2007;68(6):908-916. PMID:17592916
3. Gibbons RD,Hur K,Bhaumik DK,et al. The relationship between antidepre-ssant prescription rates and rate of early adolescent suicide. Am J Psychiatry,2006,163(11):1898-1904. PMID: 17074941
4. S?nderg?rd L,Kvist K,Lopez AG,et al. Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995-1999. Acta Psychiatr Scand, 2006,114(3):168-176. PMID:16889587
5. S?nderg?rd L,Kvist K,Andersen PK,et al. Do antidepressants prevent suicide? Int Clin Psychopharmacol,2006,21(4):211-218. PMID:16687992
6. Hibbeln JR. Fish consumption and major depression. Lancet,1998,351(9110):1213. PMID: 9643729
7. Hibbeln JR. Seafood consumption, the DHA content of mothers’milk and prevalence rates of postpartum depression: across-national, ecological analysis. J Affect Disord,2002,69(1-3):15-29. PMID:12103448
8. Noaghiul S,Hibbeln JR. Cross-national comparisons of seafood consumption and rates of bipolar disorders. Am J Psychiatry,2003,160(12):2222-2227.PMID:14638594
9. Tanskanen A, Hibbeln JR, Tuomilehto J,et al. Fish consumption and depre-ssive symptoms in the general population in Finland. Psychiatr Serv,2001, 52(4):529-531. PMID:11274502
10. Timonen M, Horrobin D, Jokelainen J,et al. Fish consumption and depress-ion: the Northern Finland 1966 birth cohort study. J Affect Disord,2004, 82(3):447-452. PMID:15555697
11. Tiemeier H,van Tuijl HR,Hofman A,et al. Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam study. Am J Clin Nutr,2003,78(1):40-46. PMID:12816769
12. Edwards R,Peet M,Shay J,et al. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients.J Affe-ct Disord,1998,48(2-3):149-155. PMID: 9543204
13. Peet M,Murphy B,Shay J,et al. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry,1998,43(5):315-319. PMID:9513745
14. Maes M,Smith R,Christophe A,et al. Fatty acid composition in major depr-ession: decreased omega-3 fractions in cholesteryl esters and increased C20:4omega 6/C20:5 omega 3 ratio in cholesteryl esters and phospholipids. J Affect Disord,1996,38(1):35-46. PMID:8735157
15. Sublette ME,Hibbeln JR,Galfalvy H,et al .Omega-3 Polyunsaturated Essential Fatty Acid Status as a Predictor of Future Suicide Risk. Am J Psychiatry, 2006,163(6):1100-1102. PMID:16741213
16. McNamara RK, Hahn CG, Jandacek R,et al. Selective Deficits in the Omega-3 Fatty Acid Docosahexaenoic Acid in the Postmortem Orbitofrontal Cortex of Patients with Major Depressive Disorder. Biol Psychiatry,2007,62(1):17-24. PMID:17188654
17. Mingming Huan,Kei Hamazaki,Yueji Sun,et al. Suicide Attempt and n-3 Fatty Acid Levels in Red Blood Cells: A Case Control Study in China. Bio.Psychiatry,2004,56(7):490-496. PMID:15450784
18. Nemets B,Stahl Z,Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder.Am J Psychiatry,2002,159(3):477-479. PMID:11870016
19. Peet M,Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry,2002,59 (10):913-919. PMID: 12365878
20. Marangell LB,Martinez JM, boyan HA,et al. A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry,2003,160(5):996-998. PMID:12727707
21. Grenyer B, Crowe T,Meyer B,et al. Fish oil supplementation in the treatment of major depression:A randomised double-blind placebo-controlled trial. Progress in Neuro- Psychopharmacology & Biological Psychiatry,2007,31(7):1393-1396. PMID: 17659823
22. Silvers KM,Wooley CC,Hamilton FC,et al. Randomised double-blind placebo -controlled trial of fish oil in the treatment of depression. Prostaglandins Leukot Essent Fatty Acids, 2005, 72(3):211-218. PMID:15664306
23. Su KP,Huang SY,Chiu CC,et al. Omega-3 fatty acids in major depressive disorder: a preliminary double-blind, placebocontrolled trial. Eur Neuropsychopharmacol, 2003, 13 (4): 267-271. PMID:12888186
24.张作记.汉密尔顿抑郁量表.中国行为医学量表手册.2001,10:134-135.
25.张作记.贝克抑郁自评问卷.中国行为医学量表手册.2001,10:130-131.
26. Beck,AT.自杀意图量表(SIS).见:何兆雄,主编.自杀病学.北京:中国中医药出版社,1997,646-647.
27. Yehuda S,Rabinovitz S,Carasso RL,et al. Fatty acids and brain peptides. Peptides, 1998, 19(2):407-419. PMID:9493877
1. Marcinko D,Martinac M,Karlovi? D,et al. Are there differences in serum cholesterol and cortisol concentrations between violent and non-violent schizophrenic male suicide attempters? Coll Antropol,2005,29(1):153-157. PMID:16117315
2. van Heeringen K,Audenaert K,Van de Wiele L,et al. Cortisol in violent sui-cidal behaviour: association with personality and monoaminergic activity. J Affect Disord, 2000,60(3):181-189. PMID:11074106
3. Pfennig A,Kunzel HE,Kern N,et al. Hypothalamus-pituitary-adrenal system regulation and suicidal behavior in depression. Biol.Psychiatry,2005,57(4):336-342. PMID:15705348
4. Kunugi H,Urushibara T,Nanko S. Combined DEX/CRH test among Japanese patients with major depression. J Psychiatr Res,2004,38(2):123-128. PMID: 14757325
5. Yerevanian BI,Feusner JD,Koek RJ,et al. The dexamethasone suppression test as a predictor of suicidal behavior in unipolar depression. J Affect Disord,2004,83(2-3):103-108. PMID: 15555702
6. Black DW,Monahan PO,Winokur G. The relationship between DST results and suicidal behavior. Ann Clin Psychiatry,2002,14(2):83-88. PMID:12238738
7. Sullivan GM,Mann JJ,Oquendo MA,et al. Low cerebrospinal fluid transthyr-etin levels in depression:correlations with suicidal ideation and low seroto-nin function. Biol Psychiatry, 2006,60(5):500-506. PMID:16487493
8. Sullivan GM,Hatterer JA,Herbert J,et al. Low levels of transthyretin in the CSF of depressed patients. Am J Psychiatry,1999,156(5):710-715. PMID: 10327903
9. Tripodianakis J,Markianos M,Rouvali O,et al. Gonadal axis hormones in psychiatric male patients after a suicide attempt. Eur Arch Psychiatry Clin Neurosci, 2007, 257(3):135-139. PMID:17131219
10. Gustavsson G,Tr?skman-Bendz L,Higley JD,et al. CSF testosterone in 43 male suicide attempters. Eur Neuropsychopharmacol,2003,13(2):105-109. PMID: 12650954
11. Spreux-Varoquaux O,Alvarez JC,Berlin I,et al. Differential abnormalities in plasma 5-HIAA and platelet serotonin concentrations in violent suicide attempters: relationships with impulsivity and depression. Life Sci,2001,69(6):647-657. PMID:11476186
12. Tripodianakis J,Markianos M, Sarantidis D,et al. Neurochemical variables in subjects with adjustment disorder after suicide attempts. Eur Psychiatry,2000,15(3):190-195. PMID: 10881216
13. Pitchot W,Hansenne M,Pinto E,et al. 5-Hydroxytryptamine 1A receptors,major depression,andsuicidal behavior. Biol Psychiatry,2005,58(11):854-858. PMID: 16139805
14. Sher L,Mann JJ,Traskman-Bendz L,et al. Lower cerebrospinal fluid homova-nillic acid levels in depressed suicide attempters. J Affect Disord,2006,90(1):83-89. PMID:16310257
15. Sher L,Carballo JJ,Grunebaum MF,et al. A prospective study of the associ-ation of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder.Bipolar Disord,2006,8(5Pt2):543-550. PMID:17042827
16. Placidi GP,Oquendo MA,Malone KM,et al. Aggressivity, suicide attempts, and depression: relationship to cerebrospinal fluid monoamine metabolite levels. Biol Psychiatry, 2001, 50(10):783-791. PMID:11720697
17. De Paermentier F,Mauger JM, Lowther S, et al. Brain alpha-adrenoceptors in depressed suicides. Brain Res,1997,757(1):60-68. PMID:9200499
18. Callado LF,Meana JJ,Grijalba B,et al. Selective increase of a2A-adrenocept-or agonist binding sites in brains of depressed suicide victims. J Neurochem,1998,70(3):1114-1123. PMID: 9489732
19. Tripodianakis J,Markianos M,Sarantidis D,et al. Biogenic amine turnover and serum cholesterol in suicide attempt. Eur Arch Psychiatry Clin Neur-osci,2002,252(1):38-43. PMID: 12056581
20. Brundin L,Bj?rkqvist M,Petersén A,et al. Reduced orexin levels in the cerebrospinal fluid of suicidal patients with major depressive disorder. Eur Neuropsychopharmacol, 2007, 17(9):573-579. PMID:17346943
21. Brundin L,Petersén A,Bj?rkqvist M,et al. Orexin and psychiatric symptoms in suicide attempters. J Affect Disord,2007,100(1-3):259-263. PMID: 17141878
22. Westling S,Ahrén B,Tr?skman-Bendz L,et al. Low CSF leptin in female suicide attempters with major depression. J Affect Disord,2004,81(1):41-48. PMID: 15183598
23. Atmaca M,Kuloglu M,Tezcan E,et al. Serum leptin and cholesterol levels in schizophrenic patients with and without suicide attempts. Acta Psychia-tr Scand,2003,108(3):208-214. PMID:12890276
24. Kim YK,Paik JW,Lee SW,et al. Increased plasma nitric oxide level associ-ated with suicide attempt in depressive patients. Prog Neuropsychopharmacol Biol Psychiatry, 2006, 30(6):1091-1096. PMID:16725247
25. Lee BH,Lee SW,Yoon D,et al. Increased plasma nitric oxide metabolites in suicide attempters. Neuropsychobiology,2006,53(3):127-132. PMID:16601363
26. Sarchiapone M,Camardese G,Roy A,et al. Cholesterol and serotonin indices in depressed and suicidal patients. J Affect Disord,2001,62(3):217-219. PMID: 11223109
27. Atmaca M,Tezcan E,Parmaksiz S,et al. Serum ghrelin and cholesterol values in suicide attempters. Neuropsychobiology,2006,54(1):59-63. PMID:17028445
28. Ozer OA,Kutanis R,Agargun MY,et al. Serum lipid levels, suicidality, and panic disorder. Compr Psychiatry,2004,45(2):95-98. PMID:14999659
29. Guillem E,Pelissolo A,Notides C,et al. Relationship between attempted sui-cide,serum cholesterol level and novelty seeking in psychiatric in-patients. Psychiatry Res,2002, 112(1):83-88. PMID:12379454
30. Lalovic A,Merkens L,Russell L,et al. Cholesterol metabolism and suicidality in Smith-Lemli-Opitz syndrome carriers. Am J Psychiatry,2004,161(11):2123-2126. PMID: 15514417
31. Atmaca M,Kuloglu M,Tezcan E,et al. Serum leptin and cholesterol values in suicide attempters. Neuropsychobiology,2002,45(3):124-127. PMID:11979060
32. Kim YK,Lee HJ,Kim JY,et al.Low serum cholesterol is correlated to suici-dality in a Korean sample.Acta Psychiatr Scand,2002,105(2):141-148. PMID: 11954543
33.郭新胜,许明智,师天元,等.抑郁症患者自杀行为与血浆、脂质、血清蛋白的关系.中国行为医学科学.2006:15:137.
34. Zhang J,McKeown RE,Hussey JR,et al. Low HDL cholesterol is associated with suicide attempt among young healthy women: the Third National He-alth and Nutrition Examination Survey. J Affect Disord,2005,89(1-3):25-33. PMID:16263178
35. Lalovic A,Levy E,Luheshi G,et al. Cholesterol content in brains of suicide co-mpleters. Int J Neuropsychopharmacol,2007,10(2):159-166. PMID:16707033
36. Vevera J,Zukov I,Morcinek T,et al. Cholesterol concentrations in violent and non-violent women suicide attempters. Eur Psychiatry,2003,18(1):23-27. PMID: 12648892
37. Coryell W,Schlesser M. Combined biological tests for suicide prediction. Psychiatry Res, 2007,150(2):187-191. PMID:17289156
38. Marcinko D,Pivac N,Martinac M. Platelet serotonin and serum cholesterol concentrations in suicidal and non-suicidal male patients with a first episo-de of psychosis. Psychiatry Res,2007,150(1):105-108. PMID:17270280
39. Kim YK,Myint AM. Clinical application of low serum cholesterol as an in-dicator for suicide risk in major depression. J Affect Disord,2004,81(2):161-166. PMID:15306143
40. Lee HJ,Kim YK. Serum lipid levels and suicide attempts. Acta Psychiatr Scand, 2003,108(3):215-221. PMID:12890277
41. McNamara RK,Hahn CG,Jandacek R,et al. Selective Deficits in the Omega-3 Fatty Acid Docosahexaenoic Acid in the Postmortem Orbitofrontal Cortex of Patients with MajorDepressive Disorder. Biol Psychiatry,2007,62(1):17-24. PMID: 17188654
42. Sublette ME,Hibbeln JR,Galfalvy H,et al. Omega-3 Polyunsaturated Essential Fatty Acid Status as a Predictor of Future Suicide Risk. Am J Psychiatry, 2006,163(6):1100-1102. PMID:16741213
43. Huan M,Hamazaki K,Sun Y,et al. Suicide Attempt and n-3 Fatty Acid Lev-els in Red Blood Cells: A Case Control Study in China. Biol.Psychiatry,2004,56(7):490-496. PMID:15450784
44. De Vriese SR,Christophe AB,Maes M. In humans, the seasonal variation in poly-unsaturated fatty acids is related to the seasonal variation in violent suicide and serotonergic markers of violent suicide. Prostaglandins Leukot Essential Fatty Acids,2004,71(1):13-18. PMID: 15172679
45. Hakkarainen R,Partonen T,Haukka J,et al. Is Low Dietary Intake of Omega-3 Fatty Acids Associated With Depression? Am J Psychiatry,2004,161(3):567-569. PMID:14992986
2. Nakagawa A,Grunebaum MF,Ellis SP,et al. Association of suicide and anti-depressant prescription rates in Japan, 1999-2003. Clin Psychiatry,2007;68(6):908-916. PMID:17592916
3. Gibbons RD,Hur K,Bhaumik DK,et al. The relationship between antidepre-ssant prescription rates and rate of early adolescent suicide. Am J Psychiatry,2006,163(11):1898-1904. PMID: 17074941
4. S?nderg?rd L,Kvist K,Lopez AG,et al. Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995-1999. Acta Psychiatr Scand, 2006,114(3):168-176. PMID:16889587
5. S?nderg?rd L,Kvist K,Andersen PK,et al. Do antidepressants prevent suicide? Int Clin Psychopharmacol,2006,21(4):211-218. PMID:16687992
6. Hibbeln JR. Fish consumption and major depression. Lancet,1998,351(9110):1213. PMID: 9643729
7. Hibbeln JR. Seafood consumption, the DHA content of mothers’milk and prevalence rates of postpartum depression: across-national, ecological analysis. J Affect Disord,2002,69(1-3):15-29. PMID:12103448
8. Noaghiul S,Hibbeln JR. Cross-national comparisons of seafood consumption and rates of bipolar disorders. Am J Psychiatry,2003,160(12):2222-2227.PMID:14638594
9. Tanskanen A, Hibbeln JR, Tuomilehto J,et al. Fish consumption and depre-ssive symptoms in the general population in Finland. Psychiatr Serv,2001, 52(4):529-531. PMID:11274502
10. Timonen M, Horrobin D, Jokelainen J,et al. Fish consumption and depress-ion: the Northern Finland 1966 birth cohort study. J Affect Disord,2004, 82(3):447-452. PMID:15555697
11. Tiemeier H,van Tuijl HR,Hofman A,et al. Plasma fatty acid composition and depression are associated in the elderly: the Rotterdam study. Am J Clin Nutr,2003,78(1):40-46. PMID:12816769
12. Edwards R,Peet M,Shay J,et al. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients.J Affe-ct Disord,1998,48(2-3):149-155. PMID: 9543204
13. Peet M,Murphy B,Shay J,et al. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Biol Psychiatry,1998,43(5):315-319. PMID:9513745
14. Maes M,Smith R,Christophe A,et al. Fatty acid composition in major depr-ession: decreased omega-3 fractions in cholesteryl esters and increased C20:4omega 6/C20:5 omega 3 ratio in cholesteryl esters and phospholipids. J Affect Disord,1996,38(1):35-46. PMID:8735157
15. Sublette ME,Hibbeln JR,Galfalvy H,et al .Omega-3 Polyunsaturated Essential Fatty Acid Status as a Predictor of Future Suicide Risk. Am J Psychiatry, 2006,163(6):1100-1102. PMID:16741213
16. McNamara RK, Hahn CG, Jandacek R,et al. Selective Deficits in the Omega-3 Fatty Acid Docosahexaenoic Acid in the Postmortem Orbitofrontal Cortex of Patients with Major Depressive Disorder. Biol Psychiatry,2007,62(1):17-24. PMID:17188654
17. Mingming Huan,Kei Hamazaki,Yueji Sun,et al. Suicide Attempt and n-3 Fatty Acid Levels in Red Blood Cells: A Case Control Study in China. Bio.Psychiatry,2004,56(7):490-496. PMID:15450784
18. Nemets B,Stahl Z,Belmaker RH. Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder.Am J Psychiatry,2002,159(3):477-479. PMID:11870016
19. Peet M,Horrobin DF. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry,2002,59 (10):913-919. PMID: 12365878
20. Marangell LB,Martinez JM, boyan HA,et al. A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry,2003,160(5):996-998. PMID:12727707
21. Grenyer B, Crowe T,Meyer B,et al. Fish oil supplementation in the treatment of major depression:A randomised double-blind placebo-controlled trial. Progress in Neuro- Psychopharmacology & Biological Psychiatry,2007,31(7):1393-1396. PMID: 17659823
22. Silvers KM,Wooley CC,Hamilton FC,et al. Randomised double-blind placebo -controlled trial of fish oil in the treatment of depression. Prostaglandins Leukot Essent Fatty Acids, 2005, 72(3):211-218. PMID:15664306
23. Su KP,Huang SY,Chiu CC,et al. Omega-3 fatty acids in major depressive disorder: a preliminary double-blind, placebocontrolled trial. Eur Neuropsychopharmacol, 2003, 13 (4): 267-271. PMID:12888186
24.张作记.汉密尔顿抑郁量表.中国行为医学量表手册.2001,10:134-135.
25.张作记.贝克抑郁自评问卷.中国行为医学量表手册.2001,10:130-131.
26. Beck,AT.自杀意图量表(SIS).见:何兆雄,主编.自杀病学.北京:中国中医药出版社,1997,646-647.
27. Yehuda S,Rabinovitz S,Carasso RL,et al. Fatty acids and brain peptides. Peptides, 1998, 19(2):407-419. PMID:9493877
1. Marcinko D,Martinac M,Karlovi? D,et al. Are there differences in serum cholesterol and cortisol concentrations between violent and non-violent schizophrenic male suicide attempters? Coll Antropol,2005,29(1):153-157. PMID:16117315
2. van Heeringen K,Audenaert K,Van de Wiele L,et al. Cortisol in violent sui-cidal behaviour: association with personality and monoaminergic activity. J Affect Disord, 2000,60(3):181-189. PMID:11074106
3. Pfennig A,Kunzel HE,Kern N,et al. Hypothalamus-pituitary-adrenal system regulation and suicidal behavior in depression. Biol.Psychiatry,2005,57(4):336-342. PMID:15705348
4. Kunugi H,Urushibara T,Nanko S. Combined DEX/CRH test among Japanese patients with major depression. J Psychiatr Res,2004,38(2):123-128. PMID: 14757325
5. Yerevanian BI,Feusner JD,Koek RJ,et al. The dexamethasone suppression test as a predictor of suicidal behavior in unipolar depression. J Affect Disord,2004,83(2-3):103-108. PMID: 15555702
6. Black DW,Monahan PO,Winokur G. The relationship between DST results and suicidal behavior. Ann Clin Psychiatry,2002,14(2):83-88. PMID:12238738
7. Sullivan GM,Mann JJ,Oquendo MA,et al. Low cerebrospinal fluid transthyr-etin levels in depression:correlations with suicidal ideation and low seroto-nin function. Biol Psychiatry, 2006,60(5):500-506. PMID:16487493
8. Sullivan GM,Hatterer JA,Herbert J,et al. Low levels of transthyretin in the CSF of depressed patients. Am J Psychiatry,1999,156(5):710-715. PMID: 10327903
9. Tripodianakis J,Markianos M,Rouvali O,et al. Gonadal axis hormones in psychiatric male patients after a suicide attempt. Eur Arch Psychiatry Clin Neurosci, 2007, 257(3):135-139. PMID:17131219
10. Gustavsson G,Tr?skman-Bendz L,Higley JD,et al. CSF testosterone in 43 male suicide attempters. Eur Neuropsychopharmacol,2003,13(2):105-109. PMID: 12650954
11. Spreux-Varoquaux O,Alvarez JC,Berlin I,et al. Differential abnormalities in plasma 5-HIAA and platelet serotonin concentrations in violent suicide attempters: relationships with impulsivity and depression. Life Sci,2001,69(6):647-657. PMID:11476186
12. Tripodianakis J,Markianos M, Sarantidis D,et al. Neurochemical variables in subjects with adjustment disorder after suicide attempts. Eur Psychiatry,2000,15(3):190-195. PMID: 10881216
13. Pitchot W,Hansenne M,Pinto E,et al. 5-Hydroxytryptamine 1A receptors,major depression,andsuicidal behavior. Biol Psychiatry,2005,58(11):854-858. PMID: 16139805
14. Sher L,Mann JJ,Traskman-Bendz L,et al. Lower cerebrospinal fluid homova-nillic acid levels in depressed suicide attempters. J Affect Disord,2006,90(1):83-89. PMID:16310257
15. Sher L,Carballo JJ,Grunebaum MF,et al. A prospective study of the associ-ation of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder.Bipolar Disord,2006,8(5Pt2):543-550. PMID:17042827
16. Placidi GP,Oquendo MA,Malone KM,et al. Aggressivity, suicide attempts, and depression: relationship to cerebrospinal fluid monoamine metabolite levels. Biol Psychiatry, 2001, 50(10):783-791. PMID:11720697
17. De Paermentier F,Mauger JM, Lowther S, et al. Brain alpha-adrenoceptors in depressed suicides. Brain Res,1997,757(1):60-68. PMID:9200499
18. Callado LF,Meana JJ,Grijalba B,et al. Selective increase of a2A-adrenocept-or agonist binding sites in brains of depressed suicide victims. J Neurochem,1998,70(3):1114-1123. PMID: 9489732
19. Tripodianakis J,Markianos M,Sarantidis D,et al. Biogenic amine turnover and serum cholesterol in suicide attempt. Eur Arch Psychiatry Clin Neur-osci,2002,252(1):38-43. PMID: 12056581
20. Brundin L,Bj?rkqvist M,Petersén A,et al. Reduced orexin levels in the cerebrospinal fluid of suicidal patients with major depressive disorder. Eur Neuropsychopharmacol, 2007, 17(9):573-579. PMID:17346943
21. Brundin L,Petersén A,Bj?rkqvist M,et al. Orexin and psychiatric symptoms in suicide attempters. J Affect Disord,2007,100(1-3):259-263. PMID: 17141878
22. Westling S,Ahrén B,Tr?skman-Bendz L,et al. Low CSF leptin in female suicide attempters with major depression. J Affect Disord,2004,81(1):41-48. PMID: 15183598
23. Atmaca M,Kuloglu M,Tezcan E,et al. Serum leptin and cholesterol levels in schizophrenic patients with and without suicide attempts. Acta Psychia-tr Scand,2003,108(3):208-214. PMID:12890276
24. Kim YK,Paik JW,Lee SW,et al. Increased plasma nitric oxide level associ-ated with suicide attempt in depressive patients. Prog Neuropsychopharmacol Biol Psychiatry, 2006, 30(6):1091-1096. PMID:16725247
25. Lee BH,Lee SW,Yoon D,et al. Increased plasma nitric oxide metabolites in suicide attempters. Neuropsychobiology,2006,53(3):127-132. PMID:16601363
26. Sarchiapone M,Camardese G,Roy A,et al. Cholesterol and serotonin indices in depressed and suicidal patients. J Affect Disord,2001,62(3):217-219. PMID: 11223109
27. Atmaca M,Tezcan E,Parmaksiz S,et al. Serum ghrelin and cholesterol values in suicide attempters. Neuropsychobiology,2006,54(1):59-63. PMID:17028445
28. Ozer OA,Kutanis R,Agargun MY,et al. Serum lipid levels, suicidality, and panic disorder. Compr Psychiatry,2004,45(2):95-98. PMID:14999659
29. Guillem E,Pelissolo A,Notides C,et al. Relationship between attempted sui-cide,serum cholesterol level and novelty seeking in psychiatric in-patients. Psychiatry Res,2002, 112(1):83-88. PMID:12379454
30. Lalovic A,Merkens L,Russell L,et al. Cholesterol metabolism and suicidality in Smith-Lemli-Opitz syndrome carriers. Am J Psychiatry,2004,161(11):2123-2126. PMID: 15514417
31. Atmaca M,Kuloglu M,Tezcan E,et al. Serum leptin and cholesterol values in suicide attempters. Neuropsychobiology,2002,45(3):124-127. PMID:11979060
32. Kim YK,Lee HJ,Kim JY,et al.Low serum cholesterol is correlated to suici-dality in a Korean sample.Acta Psychiatr Scand,2002,105(2):141-148. PMID: 11954543
33.郭新胜,许明智,师天元,等.抑郁症患者自杀行为与血浆、脂质、血清蛋白的关系.中国行为医学科学.2006:15:137.
34. Zhang J,McKeown RE,Hussey JR,et al. Low HDL cholesterol is associated with suicide attempt among young healthy women: the Third National He-alth and Nutrition Examination Survey. J Affect Disord,2005,89(1-3):25-33. PMID:16263178
35. Lalovic A,Levy E,Luheshi G,et al. Cholesterol content in brains of suicide co-mpleters. Int J Neuropsychopharmacol,2007,10(2):159-166. PMID:16707033
36. Vevera J,Zukov I,Morcinek T,et al. Cholesterol concentrations in violent and non-violent women suicide attempters. Eur Psychiatry,2003,18(1):23-27. PMID: 12648892
37. Coryell W,Schlesser M. Combined biological tests for suicide prediction. Psychiatry Res, 2007,150(2):187-191. PMID:17289156
38. Marcinko D,Pivac N,Martinac M. Platelet serotonin and serum cholesterol concentrations in suicidal and non-suicidal male patients with a first episo-de of psychosis. Psychiatry Res,2007,150(1):105-108. PMID:17270280
39. Kim YK,Myint AM. Clinical application of low serum cholesterol as an in-dicator for suicide risk in major depression. J Affect Disord,2004,81(2):161-166. PMID:15306143
40. Lee HJ,Kim YK. Serum lipid levels and suicide attempts. Acta Psychiatr Scand, 2003,108(3):215-221. PMID:12890277
41. McNamara RK,Hahn CG,Jandacek R,et al. Selective Deficits in the Omega-3 Fatty Acid Docosahexaenoic Acid in the Postmortem Orbitofrontal Cortex of Patients with MajorDepressive Disorder. Biol Psychiatry,2007,62(1):17-24. PMID: 17188654
42. Sublette ME,Hibbeln JR,Galfalvy H,et al. Omega-3 Polyunsaturated Essential Fatty Acid Status as a Predictor of Future Suicide Risk. Am J Psychiatry, 2006,163(6):1100-1102. PMID:16741213
43. Huan M,Hamazaki K,Sun Y,et al. Suicide Attempt and n-3 Fatty Acid Lev-els in Red Blood Cells: A Case Control Study in China. Biol.Psychiatry,2004,56(7):490-496. PMID:15450784
44. De Vriese SR,Christophe AB,Maes M. In humans, the seasonal variation in poly-unsaturated fatty acids is related to the seasonal variation in violent suicide and serotonergic markers of violent suicide. Prostaglandins Leukot Essential Fatty Acids,2004,71(1):13-18. PMID: 15172679
45. Hakkarainen R,Partonen T,Haukka J,et al. Is Low Dietary Intake of Omega-3 Fatty Acids Associated With Depression? Am J Psychiatry,2004,161(3):567-569. PMID:14992986