«Suicidology» №1 – 2024
Kozlov V.A., Golenkov A.V., Zotov P.B., Bulygina I.E. Debate aspects of suicidology: the relationship of neuroinflammatory with suicidal behavior in mentally healthy people. Part I. Suicidology. 2024; 15 (1): 3-30. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-3-30
A large body of literature has been accumulated, which proves that suicidal behavior (completed suicides) is induced by inflammation of the peripheral and central nervous system, which is realized as a result of congenital gene polymorphisms and/or changes in epigenomic marks. The purpose of the work is to systematize information about the role of cytokines and inflammatory chemokines in the processes of translation of genomic defects into suicidal behavior in mentally healthy people. The work examines the pathophysiology of neuroinflammation, provides molecular and cytological information that forms a natural scientific understanding of the differences between neuroinflammation with the participation of microglia, cyto- and chemokines and classical inflammation with the activation of peripheral macrophages, T-cells, and eicosotetraenoic acid products. The role of the kynurenine pathway and NMDA receptors in the formation of neuroinflammation and suicidal behavior is discussed. Shows how peripheral inflammation can induce neuroinflammation. The pathophysiology of the formation of suicidal behavior is considered using examples of the connection between neuroinflammation and its manifestations (suicidal thoughts, suicide attempts and completed suicides) in individuals without mental disorders. Conclusions: 1. Neuroinflammation changes a person’s adaptive behavioral pattern to a maladaptive one (deviant, delinquent, suicidal, pathological in the form of any obvious mental disorders) due to the fact that inflammation always disrupts function. 2. The discovery of a connection between neuroinflammation and suicidal behavior is one of the probable evidence of the biological nature of suicide. 3. Discovering the role of chronic low-grade neuroinflammation in the processes of formation of a maladaptive behavioral pattern can form an innovative approach for the development of more effective methods for the prevention and treatment of both suicidal behavior (completed suicides) and mental (personality, addictive) disorders.
Keywords: neuroinflammation, microglia, cytokines, chemokines, suicidal behavior (completed suicide), single nucleotide polymorphisms, kynurenine, tryptophan, NMDA
Gorbunova A.P., Rukavishnikov G.V., Kasyanov E.D., Kibitov A.O., Mazo G.E. Hematological coefficients of systemic inflammation as potential biomarkers of suicide. Suicidology. 2024; 15 (1): 31-52. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-31-52
Suicide is one of the leading causes of death throughout the world, however, despite the prevalence and high social significance of this problem, effective methods for diagnosing, predicting and preventing suicidal behavior have not yet been developed. The aim of this review is to systematize data on the role of inflammatory processes in the formation of suicidal risk and the possibilities of using inflammatory markers for the purpose of its prevention. The focus is on hematological ratios of systemic inflammation (neutrophil-lymphocyte (NLR), monocyte-lymphocyte (MLR) and platelet-lymphocyte (PLR) ratios, as well as systemic immune inflammation indices (SII, platelet count x neutrophil / lymphocyte count) and systemic inflammatory response (SIRI, neutrophil count x monocyte/lymphocyte count)) as easy-to-use and cost-effective indicators of a complete blood count. These ratios appear to be a promising new approach for suicide prediction and prevention. The literature analysis indicates that due to the complexity of this process, as well as the fact of the presence of an underlying mental disorder that contributes to the inflammatory process, an integrated approach to studying the role of neuroinflammation in suicidality is advisable, taking into account both biological and stress factors. environmental factors.
Keywords: neuroinflammation, hematological coefficient, cell ratio, suicide, suicidal behavior
Lyubov E.B., Zotov P.B. Intentional self-harming behavior in borderline personality disorders. Part III: diagnosis and treatment. Suicidology. 2024; 15 (1): 53-82. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-53-82
The literature review is based on searching the keywords “borderline personality disorder” (BPD), “non-suicidal self-harm” and “suicidal behavior” in MEDLINE and PsycINFO for articles since 2000. The third and final part focuses on the diagnostic process, objectification of the medical and social burden and the selection of evidence-based comprehensive treatment for patients with BPD as an important resource-saving and anti-suicidal remedy.
Keywords: borderline personality disorder, diagnosis, treatment
Rozanov V.A., Samerkhanova К.М., Shaboltas A.V. Smartphones and suicide prevention (short narrative review of specialized mobile APPS). Suicidology. 2024; 15 (1): 83-104. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-83-104
Objective. To provide a brief narrative review of studies analyzing the effectiveness of mobile apps developed for suicide prevention (SPMA), to review some examples of available apps in terms of functionality and design. Results. A review of the ten SPMAs available for downloading in the Russian Federation showed that self-help applications predominate among them (70%), while a smaller share (20%) is made up of SPMAs that are aimed to provide assistance to a loved one, while some apps provide both options. One application is intended for medical workers and is supposed to help prevent suicide among their patients. SPMAs are built using general principles and usually include information on myths and facts about suicide, warning signs, risk factors, recommendations on how to behave with a suicidal person, what to say, what questions to ask and how to help. Virtually all SPMAs contain a list of resources that provide professional assistance that are relevant to the region where the SPMA is being used, or more broadly (helplines, websites, medical facilities). In half of all SPMAs, the development of an individual safety plan constitutes a central tool. Some SPMAs utilize relaxation and calming techniques, breathing exercises, and techniques to prevent self-harm. While systematic reviews of researches on the effectiveness of SPMs generally present positive findings, many reviews are critical, mainly concerning the need for professional assessment of SPMAs. Earlier reviews suggest limited efficacy of SPMAs, while the most recent reviews are more optimistic, with a growing number of RCTs aimed at assessing the efficacy of these applications. Conclusion. SPMAs are quite relevant to take their place in the system of suicide prevention, taking into account their mobility, accessibility, possibility of pe rsonalization, and adherence to recognized tactics and prevention strategies. When creating Russian-language SPMAs, it is desirable to ensure constant interaction between potential users (patients and their relatives), professionals in the field of prevention, designers and technical developers.
Keywords: suicide prevention, mobile apps, evaluation of effectiveness, perspectives
Merinov A.V., Shishkova I.M., Emec N.A., Novichkova A.S., Kosy’reva А.V. Suicide and psychiatry: the suicidal person is more likely to be ill or rather healthy. Reflections on the psychiatric qualification of suicide, awareness of actions and the truth of intentions. Suicidology. 2024; 15 (1): 105-142. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-105-142
The results of the senior medical students’ answers the question: "Does a person who commits suicide necessarily suffer from any kind of mental disorder?" served as a starting point to this work. The number of positive responses tended to reach 100%. Suicidal behavior for many people is a frightening, odious and mysterious topic, which in no way is able to characterize a mentally healthy person. The purpose of the work is to assess the presence of a psychiatric or narcological disorder (established or suspected) and its possible impact on suicide (or attempt) by analyzing fairly common clinical cases in practice. Materials and methods. 28 observations of completed suicides, suicide attempts and accidents as a result of demonstrative blackmail actions were analyzed from a clinical perspective in the work. The methods of psychiatric and psychological autopsies were used. Results. It has been demonstrated that suicidal and parasuicidal behavior, being separate clinical phenomena in themselves, accompany the entire continuum of "norm – mental pathology". There are options for suicide with and without understanding the essence of the actions performed on oneself (awareness of the nature and purpose of the plan and without them), with the presence of a clear volitional controlling component and with a significant decrease or perversion of the latter. The relationship between the presence of mental illness and suicide is multifaceted, ranging from the undoubted participation of the disease in the stages of suicidogenesis to the absence of such (even in persons who were in a psychotic state at the time of death). In case of death at the time of a psychotic state, it is reasonable to use the following models of combining the existing disorder and suicide: with the unconditional influence of psychotic symptoms and with awareness of the consequences of the actions performed – suicide induced by a psychotic state; with unconditional influence, but without awareness of the consequences – true psychotic suicide or psychotic pseudo–suicide; with unconditional influence, but without a true desire to die – transformational psychotic suicide; conscious escape through suicide from experiences created by a mental disorder - parapsychotic suicide. Affective shock variants of the induction of suicidal behavior, with their rather significant prevalence, are rarely diagnosed in vivo due to the parallelism of their formation to suicidal behavior. This is often an option only for postmortem diagnosis with the involvement of a psychiatric autopsy manual. Conclusions. The very fact of the presence of a psychiatric diagnosis, without assessing the context of what happened and the presence of cause-and-effect relationships, means little in itself. It is permissible only to talk about diagnoses of different ranks of suicidal significance. The methodology for evaluating such a combination should be taken into account in the case of suicide in a mentally conditionally healthy person. A retrospective calculation of previously established psychiatric or narcological diagnoses in suicide victims gives us a significant number of healthy individuals. When conducting a psychological or psychiatric autopsy, we are more likely to find indications of a possible psychiatric "abnormality".
Keywords: suicidology, auto-aggressive behavior, psychiatric autopsy, psychological autopsy, suicide without suicide, parapsychotic suicide, psychotic pseudosuicide, true psychotic suicide, psychotic induced suicide, transformational psychotic suicide
Lyubov E.B. «There are women who are to lie beneath the sod»: the faces of the literature suicide. Part I: no and yes. Suicidology. 2024; 15 (1): 143-169. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-143-169
Based on the prose of the 19th-20th centuries (for the most part), typical features of “literary” and/or “female” suicides (thanatological images) are highlighted in the broad cultural-historical and philosophical contexts of genre and narratology with clarification of the “life-death” coordinates and the relationship literature and life. The analysis is based on clinical (phenomenological), biographical, typological approaches, and the method of literary hermeneutics.
Keywords: story, suicidal behavior, women
Kornetova E.G., Galkin S.A., Kornetov A.N., Mednova I.A., Kozlova S.M., Bokhan N.A. Cross psychometric study of patients with paranoid schizophrenia with or without a history of suicide attempts. Suicidology. 2024; 15 (1): 170-182. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-170-182
Suicide is one of the leading causes of premature mortality in patients with schizophrenia, and suicide attempts are recognized as key factors in predicting suicide. Patients with schizophrenia who have attempted suicide tend to be young, lonely, and have more severe depressive symptoms. Among hospitalized patients, suicide risk peaks shortly after hospital discharge. The rate of suicide attempts is significantly higher in men with schizophrenia rather than in women. Some studies have shown that people with schizophrenia who attempted suicide had better cognitive functions indicators. The suicidal behavior is still typical of these patients, and up till today the search for connections between suicidal actions, the socio-demographic status of patients, clinical symptoms, including cognitive impairment in schizophrenia stays relevant. Aim of the study: to determine the relationships between a history of suicide attempts, symptom clusters (factors) obtained as a result of a five-factor analysis of the Positive and Negative Syndrome Scale (PANSS), and cognitive impairment in a group of inpatients with paranoid schizophrenia receiving drug treatment. Materials and methods. 109 patients with paranoid schizophrenia (60 men and 49 women) were examined. All individuals included in the study were examined using the Brief Assessment of Cognition in Schizophrenia (BACS) scale in an adapted Russian version. The severity of psychopathological symptoms was assessed using the five-factor model of the Positive and Negative Syndrome Scale (PANSS). The analysis of suicidal activity was carried out retrospectively (anamnestic). Results. The prevalence of suicide attempts in the entire sample of patients with paranoid schizophrenia equaled 18.3%. Patients who had attempted suicide had statistically significantly higher PANSS scores on the positive (p=0.047) and depressive (p=0.039) factors compared to patients without suicide attempts. However, there was no statistically significant difference in scores in the negative (p=0.429), cognitive (p=0.771) and arousal factor (p=0.735). Compared with patients without a history of attempts, patients with suicide attempts showed statistically significantly lower scores only on the BACS Motor Test with Chips subtest (p = 0.041). No statistically significant differences were found for the remaining subtests (p>0.05). According to multiple regression analysis, it was found that the positive factor of PANSS (β=1.561; p=0.018), the depressive factor of PANSS (β=1.614; p=0.012) and scores in the BACS “Motor Test with Chips” (β= –1.657; p=0.016) were independent factors correlated with suicide attempts in schizophrenia. Conclusion. It has been established that suicide attempts in patients with paranoid schizophrenia correlate with the severity of positive and depressive symptoms on the PANSS scale, as well as with a decrease in motor function scores on the BACS scale.
Keywords: schizophrenia, suicide attempts, cognitive impairment, positive factor, depressive factor
Zotov P.B., Mateikovich E.A., Zhmurov V.A., Sakharov S.P., Senatorova O.V., Koltashev I.V., Sergejchik O.I., Akselrov E.M. Drotaverine is among the means of suicidal actions. Suicidology. 2024; 15 (1): 183-202. (In Russ / Engl) doi.org/10.32878/suiciderus.24-15-01(54)-183-202
Drotaverine is one of the most popular medicines in the general population in Russia; it is widely used at home as a means of self-medication for various painful manifestations, mainly associated with disorders in the digestive and genitourinary systems. Taken in large doses, the drug causes severe complications, and if timely assistance is not provided, it can be fatal. These properties can be used to implement suicidal actions. The lack of a recording system currently does not allow us to determine the real rates of poisoning with this drug. This limits the possibility of a more complete study and description of the leading characteristics of the suicidal population, identifying risk groups, key motives and anti-suicidal factors. Currently, preventive measures have been poorly developed and require improvement. Summarizing the data of predominantly isolated observations presented in the literature, it can be noted that among those who use drotaverine (no-shpa) for suicidal actions, women predominate. As a rule, these are young and middle-aged people with little education and suffering from depression. In the case of simultaneous intake of large doses of a toxicant (one package or more), the true motives to die prevail. In the absence of help, death occurs after a few hours, mainly from cardiac dysfunction. This determines the importance of improving and implementing preventive measures, including general issues and work with risk groups, limiting access to toxicants, increasing the level of thematic training of medical personnel, working with the media and Internet resources. Considering the relevance of the problem and the objectively poor development of suicide prevention measures, more in-depth studies of this issue are justified.
Keywords: drotaverine, no-spa, poisoning, drotaverine poisoning, suicidal poisoning, suicidal attempt, suicide, suicide