18 More than half of suicide attempts: A review of eight studies shows that one-third to four-fifths of suicidal acts occurred with little premeditation. The modal figure was two-thirds. See C. L. Williams, J. A. Davidson, and I. Montgomery, “Impulsive Suicidal Behavior,” Journal of Clinical Psychology, 36 (1980): 90–94.
19 many researchers and clinicians: A. Apter, R. Plutchik, and H. M. van Praag, “Anxiety, Impulsivity and Depressed Mood in Relation to Suicidal and Violent Behavior,” Acta Psychiatrica Scandinavica, 87 (1993): 1–5; P. Nordström, P. Gustavsson, G. Edman, and M. Åsberg, “Temperamental Vulnerability and Suicide Risk After Attempted Suicide,” Suicide and Life-Threatening Behavior, 26 (1996): 380–394.
20 Professional handwriting analysts: C. J. Frederick, “An Investigation of Handwriting of Suicide Persons Through Suicide Notes,” Journal of Abnormal Psychology, 73 (1968): 263–267.
21 Suicidal patients, in addition: M. Weissman, K. Fox, and G. L. Klerman, “Hostility and Depression Associated with Suicide Attempts,” American Journal of Psychiatry, 130 (1973): 450–455; J. A. Yesavage, “Direct and Indirect Hostility and Self-Destructive Behavior by Hospitalized Depressives,” Acta Psychiatrica Scandinavica, 68 (1983): 345–350; J. Angst and P. Clayton, “Premorbid Personality of Depressive, Bipolar, and Schizophrenic Patients with Special Reference to Suicidal Issues,” Comprehensive Psychiatry, 27 (1986): 511–532; A. J. Botsis, C. R. Soldatos, A. Liossi, A. Kokkevi, and C. N. Stephanis, “Suicide and Violence Risk: I. Relationship to Coping Styles,” Acta Psychiatrica Scandinavica, 89 (1994): 92–96; M. Åsberg, “Neurotransmitters and Suicidal Behavior: The Evidence from Cerebrospinal Fluid Studies,” Annals of the New York Academy of Sciences, 836 (1998): 158–181; J. J. Mann, C. Waternaux, G. L. Haas, and K. M. Malone, “Toward a Clinical Model of Suicidal Behavior in Psychiatric Patients,” American Journal of Psychiatry, 156 (1999): 181–189.
22 those who actually killed themselves: B. M. Barraclough, J. Bunch, B. Nelson, and P. Sainsbury, “A Hundred Cases of Suicide: Clinical Aspects,” British Journal of Psychiatry, 125 (1974): 355–372.
23 homicide is frequently followed: D. J. West, Murder Followed by Suicide (London: Heinemann, 1966); J. Hansen and O. Bjarneson, “Homicide in Iceland,” Forensic Sciences, 4 (1974): 107–117; S. Dalmer and J. A. Humphrey, “Offender-Victim Relationships in Criminal Homicide Followed by Offenders’ Suicide: North Carolina 1972–1977,” Suicide and Life-Threatening Behavior, 10 (1980): 106–118; H. Petursson and G. H. Gudjonsson, “Psychiatric Aspects of Homicide,” Acta Psychiatrica Scandinavica, 64 (1981): 363–372; N. H. Allen, “Homicide Followed by Suicide: Los Angeles, 1970–1979,” Suicide and Life-Threatening Behavior, 13 (1983): 155–165; J. Coid, “The Epidemiology of Abnormal Homicide and Murder Followed by Suicide,” Psychological Medicine, 13 (1983): 855–860; D. C. Blanchard and R. J. Blanchard, “Affect and Aggression: An Animal Model Applied to Human Behavior,” in R. J. Blanchard and D. C. Blanchard, eds., Advances in the Study of Aggression, vol. 1 (New York: Academic Press, 1984).
24 Nearly 50 percent of all manic episodes: Based on a review of studies in F. K. Goodwin and K. R. Jamison, Manic-Depressive Illness (New York: Oxford University Press, 1990), pp. 35–37; see also G. Winokur, P. J. Clayton, and T. Reich, Manic Depressive Illness (St. Louis: C. V. Mosby, 1969).
25 a link between serotonin functioning: In addition to the animal studies cited earlier, see also M. Åsberg, D. Schalling, L. Träskman-Bendz, and A. Wagner, “Psychobiology of Suicide, Impulsivity, and Related Phenomena,” in H. Y. Meltzer, ed., Psychopharmacology: The Third Generation of Progress (New York: Raven Press, 1987), pp. 655–668; E. F. Coccaro, “Central Serotonin and Impulsive Aggression,” British Journal of Psychiatry, 155 (1989): 52–62; M. Virkkunen, J. De Jong, J. Bartko, and M. Linnoila, “Psychobiological Concomitants of History of Suicide Attempts Among Violent Offenders and Impulsive Fire Setters,” Archives of General Psychiatry, 46 (1989): 604–606; G. L. Brown and M. I. Linnoila, “CSF Serotonin Metabolite (5-HIAA) Studies in Depression, Impulsivity, and Violence,” Journal of Clinical Psychiatry, 51 (1990): 31–41.
26 one of the most replicated findings: G. L. Brown, F. K. Goodwin, J. C. Ballenger, P. F. Goyer, and L. F. Major, “Aggression in Humans Correlates with Cerebrospinal Fluid Amine Metabolites,” Psychiatry Research, 1 (1979): 131–139; G. L. Brown, F. K. Goodwin, and W. E. Bunney, “Human Aggression and Suicide: Their Relationship to Neuropsychiatric Diagnoses and Serotonin Metabolism,” Advances in Biochemistry and Psychopharmacology, 34 (1982): 287–307; H. van Praag, “Depression, Suicide, and Metabolism of Serotonin in the Brain,” Journal of Affective Disorders, 4 (1982): 275–290; C. M. Banki and M. Arató, “Relationship Between Cerebrospinal Fluid Amine Metabolites, Neuroendocrine Findings and Personality Dimensions (Marke-Nyman Scale Factors) in Psychiatric Patients,” Acta Psychiatrica Scandinavica, 67 (1983): 272–280; P. T. Ninan, D. P. van Kammen, M. Scheinin, M. Linnoila, W. E. Bunney, Jr., and F. K. Goodwin, “CSF 5-Hydroxyindoleacetic Acid Levels in Suicidal Schizophrenic Patients,” American Journal of Psychiatry, 141 (1984): 566–569; R. Limson, D. Goldman, A. Roy, et al., “Personality and Cerebrospinal Fluid Monoamine Metabolites in Alcoholics and Controls,” Archives of General Psychiatry, 48 (1991): 437–441.
27 Although some scientists have questioned: W. Annitto and B. Shopsin, “Neuropharmacology of Mania,” in B. Shopsin, ed., Manic Illness (New York: Academic Press, 1979), pp. 105–164; D. Healy, “The Fluoxetine and Suicide Controversy: A Review of the Evidence,” CNS Drugs, 1 (1994): 223–231.
28 more than twenty studies: M. Åsberg, “Neurotransmitters and Suicidal Behavior: The Evidence from Cerebrospinal Fluid Studies,” Annals of the New York Academy of Sciences, 836 (1997): 158–181.
29 if CSF 5-HIAA is measured: L. Träskman, M. Åsberg, L. Bertilsson, and L. Sjöstrand, “Monoamine Metabolities in CSF and Suicidal Behavior,” Archives of General Psychiatry, 38 (1981): 631–636; A. Roy, H. Ågren, D. Pickar, M. Linnoila, A. R. Doran, N. R. Cutler, and S. M. Paul, “Reduced CSF Concentrations of Homovanillic Acid and Homovanillic Acid to 5-Hydroxyindoleacetic Acid Ratios in Depressed Patients: Relationship to Suicidal Behavior and Dexamethasone Non-Suppression,” American Journal of Psychiatry, 143 (1986): 1539–1545; P. Nordström, M. Samuelsson, M. Åberg-Wistedt, C. Nordin, and L. Bertilsson, “CSF 5-HIAA Predicts Suicide Risk After Attempted Suicide,” Suicide and Life-Threatening Behavior, 24 (1994): 1–9.
30 psychiatric and behavioral syndromes: D. J. Cohen, B. A. Shaywitz, B. Caparulo, J. G. Young, and M. B. Bowers, “Chronic, Multiple Tics of Gilles de la Tourette’s Disease: CSF Acid Monoamine Metabolites After Probenecid Administration,” Archives of General Psychiatry, 35 (1978): 245–250; M. Åsberg, P. Thorén, and L. Bertilsson, “Clomipramine Treatment of Obsessive-Compulsive Disorder—Biochemical and Clinical Aspects,” Psychopharmacology Bulletin, 18 (1982): 13–21; G. L. Brown, M. H. Ebert, P. F. Goyer, D. C. Jimerson, W. J. Klein, W. E. Bunney, and F. K. Goodwin, “Aggression, Suicide, and Serotonin: Relationships to CSF Amine Metabolites,” American Journal of Psychiatry, 139 (1982): 741–746; M. Linnoila, M. Virkkunen, M. Scheinin, A. Nuutila, R. Rimon, and F. K. Goodwin, “Low Cerebrospinal Fluid 5-Hydroxyindoleacetic Acid Concentration Differentiates Impulsive from Nonimpulsive Violent Behavior,” Life Sciences, 33 (1983): 2609–2614; W. H. Kaye, M. H. Ebert, H. E. Gwirtsman, and S. R. Weiss, “Differences in Brain Serotonergic Metabolism Between Nonbulimic and Bulimic Patients with Anorexia Nervosa,” American Journal of Psychiatry, 141 (1984): 1598–1601; T. R. Insel, E. A. Mueller, I. Alterman, M. Linnoila, and D. L. Murphy, “Obsessive-Compulsive Disorder and Serotonin: Is There a Connection?” Biological Psychiatry, 20 (1985): 1174–1188; H. M. Van Praag, “Affective Disorders and Aggression Disorders: Evidence for a Common Biological Mechanism,” Suicide and Life-Threatening Behavior, 16 (1986): 103–132; M. J. Kruesi, “Cruelty to Animals and CSF 5-HIAA,” Psychiatry Research, 28 (1989): 115–116; D. C. Jimerson, M. D. Lessem, W. H. Kaye, A. P. Hegg, and T. D. Brewerton, “Eating Disorders and Depressi
on: Is There a Serotonin Connection?” Biological Psychiatry, 28 (1990): 443–454; M. J. P. Kruesi, J. L. Rapoport, E. Hibbs, W. Z. Potter, M. Lenane, and G. L. Brown, “Cerebrospinal Monoamine Metabolites, Aggression, and Impulsivity in Disruptive Disorders of Children and Adolescents,” Archives of General Psychiatry, 47 (1990): 419–426; W. H. Kaye, H. E. Gwirtsman, D. T. George, and M. H. Ebert, “Altered Serotonin Activity in Anorexia Nervosa After Long-Term Weight Restoration: Does Elevated Cerebrospinal Fluid 5-Hydroxyindoleacetic Acid Level Correlate with Rigid and Obsessive Behavior?” Archives of General Psychiatry, 48 (1991): 556–562; R. Limson, D. Goldman, A. Roy, D. Lamparski, B. Ravitz, B. Adinoff, and M. Linnoila, “Personality and Cerebrospinal Fluid Monoamine Metabolites in Alcoholics and Controls,” Archives of General Psychiatry, 48 (1991): 437–441; D. C. Jimerson, M. D. Lesem, W. H. Kaye, and T. D. Brewerton, “Low Serotonin and Dopamine Metabolite Concentrations in Cerebrospinal Fluid from Bulimic Patients with Frequent Binge Episodes,” Archives of General Psychiatry, 49 (1992): 132–138; S. E. Swedo, H. L. Leonard, M. J. Kruesi, D. C. Rettew, S. J. Listwak, W. Berettini, M. Stipetic, S. Hamburger, P. W. Gold, W. Z. Potter, and J. L. Rapoport, “Cerebrospinal Fluid Neurochemistry in Children and Adolescents with Obsessive-Compulsive Disorder,” Archives of General Psychiatry, 49 (1992): 29–36; M. Virkkunen, E. Kallio, R. Rawlings, R. Tokola, R. E. Poland, A. Guidotti, C. Nemeroff, G. Bissette, K. Kalogeras, S. L. Karonen, and M. Linnoila, “Personality Profiles and State Aggressiveness in Finnish Alcoholics, Violent Offenders, Fire Setters, and Healthy Volunteers,” Archives of General Psychiatry, 51 (1994): 28–33.
31 Smoking cigarettes: R. S. Paffenbarger Jr. and D. P. Asnes, “Chronic Disease in Former College Students: III. Precursors of Suicide in Early and Middle Life,” American Journal of Public Health, 56 (1966): 1026–1036; P. S. Paffenbarger Jr., S. H. King, and A. L. Wing, “Chronic Disease in Former College Students: IX. Characteristics in Youth That Predispose to Suicide and Accidental Death in Later Life,” American Journal of Public Health, 59 (1969): 900–908; C. B. Thomas, “Suicide Among Us: II. Habits of Nervous Tension as Potential Predictors,” Hopkins Medical Journal, 129 (1971): 190–201; C. B. Thomas, “Precursors of Premature Disease and Death: The Predictive Potential of Habits and Family Attitudes,” Annals of Internal Medicine, 85 (1976): 653–658; K. M. Malone, C. Waternaux, G. L. Haas, and J. J. Mann, “Alcohol Abuse, Cigarette Smoking, Suicidal Behavior and Serotonin Function,” Biological Psychiatry, 41 (Suppl.) (1997): 9; J. Angst and P. J. Clayton, “Personality, Smoking and Suicide,” Journal of Affective Disorders, 51 (1998): 55–62; P. Clayton, “Smoking and Suicide,” Journal of Affective Disorders, 50 (1998): 1–2; J. J. Mann, C. Waternaux, G. L. Haas, and K. M. Malone, “Toward a Clinical Model of Suicidal Behavior in Psychiatric Patients,” American Journal of Psychiatry, 156 (1999): 181–189.
32 postmortem studies: M. Stanley and B. Stanley, “Biochemical Studies in Suicide Victims: Current Findings and Future Implications,” Suicide and Life-Threatening Behavior, 19 (1989): 30–42; J. E. Kleinman, T. M. Hyde, and M. M. Herman, “Methodological Issues in the Neuropathology of Mental Illness,” in F. E. Bloom and D. J. Kupfer, eds., Psychopharmacology: The Fourth Generation of Progress (New York: Raven Press, 1995), pp. 859–864; V. Arango, M. D. Underwood, and J. J. Mann, “Fewer Pigmented Locus Ceruleus Neurons in Suicide Victims: Preliminary Results,” Biological Psychiatry, 39 (1996): 112–120; V. Arango, M. D. Underwood, and J. J. Mann, “Postmortem Findings in Suicide Victims: Implications for In Vivo Imaging Studies,” Annals of the New York Academy of Sciences, 836 (1997): 269–287; S. E. Bachus, T. M. Hyde, M. Akil, C. Shannon Weickert, M. P. Vawter, and J. E. Kleinman, “Neuropathology of Suicide: A Review and an Approach,” Annals of the New York Academy of Sciences, 836 (1997): 201–219; J. F. López, D. M. Vázquez, D. T. Chalmers, and S. J. Watson, “Regulation of 5-HT Receptors and the Hypothalamic-Pituitary-Adrenal Axis,” Annals of the New York Academy of Sciences, 836 (1997): 106–134; G. A. Ordway, “Pathophysiology of the Locus Coeruleus in Suicide,” Annals of the New York Academy of Sciences, 836 (1997): 233–252; J. J. Mann and V. Arango, “The Neurobiology of Suicidal Behavior,” in D. G. Jacobs, The Harvard Medical School Guide to Suicide Assessment and Intervention (San Francisco: Jossey-Bass, 1999): 98–114.
33 Rats, if subjected: P. Rosenfeld, Y. R. Gutierrez, A. M. Martin, H. A. Mallet, E. Alleva, and S. Levine, “Maternal Regulation of the Adrenocortical Response in Preweanling Rats,” Physiology and Behavior, 50 (1991): 661–671; D. M. Vázquez and H. Akil, “Pituitary-Adrenal Response to Ether Vapor in the Weanling Animal: Characterization of the Inhibitory Effect of Glucocorticoids on Adrenocorticotropin Secretion,” Pediatric Research, 34 (1993): 646–653; S. Levine, “The Ontogeny of the Hypothalamic-Pituitary-Adrenal Axis: The Influence of Maternal Factors,” Annals of the New York Academy of Sciences, 746 (1994): 275–288; C. O. Ladd, M. J. Owens, and C. B. Nemeroff, “Persistent Changes in Corticotropin-Releasing Factor Neuronal Systems Induced by Maternal Deprivation,” Endocrinology, 137 (1996): 1212–1218.
34 Autopsy studies: K. Dorovini-Zis and A. P. Zis, “Increased Adrenal Weight in Victims of Violent Suicide,” Endocrinology, 144 (1987): 1214–1215; C. B. Nemeroff, M. J. Owens, G. Bissette, A. C. Andorn, and M. Stanley, “Reduced Corticotropin Releasing Factor Binding Sites in the Frontal Cortex of Suicide Victims,” Archives of General Psychiatry, 45 (1988): 577–579; M. Arato, C. M. Banki, G. Bissette, and C. B. Nemeroff, “Elevated CSF CRF in Suicide Victims,” Biological Psychiatry, 25 (1989): 355–359; J. F. López, M. Palkovits, M. Arato, A. Mansour, H. Akil, and S. J. Watson, “Localization and Quantification of Pro-Opiomelanocortin mRNA and Glucocorticoid Receptor mRNA in Pituitaries of Suicide Victims,” Neuroendocrinology, 56 (1992): 491–501; E. Szigethy, Y. Conwell, N. T. Forbes, C. Cox, and E. D. Caine, “Adrenal Weight and Morphology in Victims of Completed Suicide,” Biological Psychiatry, 36 (1994): 374–380.
35 enlargement of the amygdala: L. L. Altshuler, G. Bartzokis, T. Grieder, J. Curran, and J. Mintz, “Amygdala Enlargement in Bipolar Disorder and Hippocampal Reduction in Schizophrenia: An MRI Study Demonstrating Neuroanatomic Specificity,” Archives of General Psychiatry, 55 (1998): 663–664; S. M. Strakowski, M. P. Del Bello, K. W. Sax, M. E. Zimmerman, P. K. Shear, J. M. Hawkins, and E. R. Larson, “Brain Magnetic Resonance Imaging of Structural Abnormalities in Bipolar Disorder,” Archives of General Psychiatry, 56 (1999): 254–260.
36 increase in white-matter lesions: R. M. Dupont, T. L. Jernigan, and N. Butters, “Subcortical Abnormalities Detected in Bipolar Affective Disorder Using Magnetic Resonance Imaging,” Archives of General Psychiatry, 47 (1990): 55–59; V. W. Swayze, N. C. Andreasen, R. J. Alliger, J. C. Ehrhardt, and W. T. Yuh, “Structural Brain Abnormalities in Bipolar Affective Disorder: Ventricular Enlargement and Focal Signal Hyperintensities,” Archives of General Psychiatry, 47 (1990): 1054–1059; G. S. Figiel, K. R. R. Krishnan, V. P. Rao, M. Doraiswamy, E. H. Ellinwood, C. B. Nemeroff, D. Evans, and O. Boyko, “Subcortical Hyperintensities on Brain Magnetic Resonance Imaging: A Comparison of Normal and Bipolar Subjects,” Journal of Neuropsychiatry and Clinical Neuroscience, 3 (1991): 18–22; S. M. Strakowski, B. T. Woods, M. Tohen, D. R. Wilson, A. W. Douglass, and A. L. Stoll, “MRI Subcortical Hyperintensities in Mania at First Hospitalization,” Biological Psychiatry, 33 (1993): 204–206; E. P. Ahearn, D. C. Steffens, F. Cassidy, S. A. Van Meter, J. M. Provenzale, M. F. Seldin, R. H. Weisler, and K. R. R. Krishnan, “Family Leukoencephalopathy in Bipolar Disorder,” American Journal of Psychiatry, 155 (1998): 1605–1607.
37 severe depletions: D. Öngür, W. C. Drevets, and J. L. Price, “Glial Reduction in the Subgenual Prefrontal Cortex in Mood Disorders,” Proceedings of the National Academy of Sciences USA, 95 (1998): 13290–13295.
38 brains of patients with chronic schizophrenia: A. B. Levy, N. Kurtz, and A. S. Kling, “Association Between Cerebral Ventricular Enlargement and Suicide Attempts in Chronic Schizophrenia,” American Journal of Psychiatry, 141 (1984): 438–439.
39 w
hite-matter lesions: O. L. Lopez, J. T. Becker, C. F. Reynolds, C. A. Jungreis, S. Weinman, and S. T. De Kosky, “Psychiatric Correlates of MR Deep White Matter Lesions in Probable Alzheimer’s Disease,” Journal of Neuropsychiatry and Clinical Neurosciences, 9 (1997): 246–250.
40 hyperintensities in the periventricular region: Personal communication from Dr. Eileen Ahearn, March 8, 1999.
41 Concerned by reports: D. Jacobs, H. Blackburn, M. Higgins, D. Reed, H. Iso, G. McMillan, J. Neaton, J. Nelson, J. Potter, B. Rifkind, J. Rossouw, R. Shekelle, and S. Yusuf, “Report of the Conference on Low Blood Cholesterol: Mortality Associations,” Circulation, 86 (1992): 1046–1060; M. F. Muldoon and S. B. Manuck, “Health Through Cholesterol Reduction: Are There Unforeseen Risks?” Annals of Behavioral Medicine, 14 (1992): 101–108; J. D. Neaton, H. Blackburn, D. Jacobs, L. Kuller, D. J. Lee, R. Sherwin, J. Shih, J. Stamler, and D. Wentworth, “Serum Cholesterol Level and Mortality Findings for Men Screened in the Multiple Risk Factor Intervention Trial,” Archives of Internal Medicine, 152 (1992): 1490–1500; M. F. Muldoon, J. Rossouw, S. B. Manuck, C. J. Glueck, J. R. Kaplan and P. Kaufmann, “Low or Lowered Cholesterol and Risk of Death from Suicide and Trauma,” Metabolism, 42 (Suppl. 1) (1993): 45–56.
42 Not every study: For reviews of the cholesterol-suicide link, see P. F. Boston, S. M. Durson, and M. A. Reveley, “Cholesterol and Mental Disorder,” British Journal of Psychiatry, 169 (1996): 682–689; and M. Hillbrand and R. T. Spitz, eds., Lipids, Health, and Behavior (Washington, D.C.: American Psychological Association, 1997).
43 simply an artifact: K. Hawton, P. Cowen, D. Owens, et al., “Low Serum Cholesterol and Suicide,” British Journal of Psychiatry, 162 (1993): 818–825.
44 a few studies: N. Takei, H. Kunugi, S. Nanko, H. Aoki, R. Iyo, and H. Kazamatsuri, “Low Serum Cholesterol and Suicide Attempts,” British Journal of Psychiatry, 164 (1994): 702–703; J. Fawcett, K. A. Busch, D. Jacobs, H. M. Kravitz, and L. Fogg, “Suicide: A Four-Pathway Clinical-Biochemical Model,” Annals of the New York Academy of Sciences, 836 (1997): 288–301.
Night Falls Fast Page 39