title: A prospective study of the association of cerebrospinal fluid monoamine metabolite levels with lethality of suicide attempts in patients with bipolar disorder.
abstract: OBJECTIVE
  Bipolar disorder is a severe illness that is associated with suicidal behavior. A biological predictor of highly lethal suicide attempts in patients with bipolar disorder would be valuable. We hypothesized that cerebrospinal fluid (CSF) monoamine metabolite levels are related to lethality of suicide attempts in bipolar patients and examined the relation between CSF 5-hydroxyindolacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) levels and maximum lethality of suicide attempts at baseline and during a 2-year follow up.
  
  
  METHODS
  Twenty-seven bipolar depressed patients participated in the study. Demographic and clinical parameters were examined and recorded. Lumbar punctures were performed and CSF 5-HIAA, HVA, and MHPG were assayed by high-performance liquid chromatography with electrochemical detection. Following discharge, patients were evaluated after 3 months, 1 year, and 2 years. Each follow-up interview included an in-depth assessment of suicidal behavior during the intervening time period.
  
  
  RESULTS
  Six subjects made suicide attempts during the 2-year follow-up. Bipolar patients who attempted suicide during the follow-up period had higher aggression and hostility scale scores compared to bipolar subjects who did not make a suicide attempt during the follow-up period. CSF 5-HIAA, HVA, and MHPG levels were negatively correlated with the maximum lethality of suicide attempts during the 2-year follow-up period.
  
  
  CONCLUSIONS
  Our finding is the first observation that CSF monoamine metabolite levels may be predictors of lethality of suicide attempts in patients with bipolar disorder. Further studies are necessary to answer the question whether CSF monoamine metabolite levels are clinically useful biochemical predictors of highly lethal suicide attempts or completed suicides.
authors.affiliation: Division of Neuroscience, Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA. LS2003@columbia.edu
authors.forename: Leo
authors.initials: L
authors.lastname: Sher
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Carballo
authors.forename: Michael F
authors.initials: MF
authors.lastname: Grunebaum
authors.forename: Ainsley K
authors.initials: AK
authors.lastname: Burke
authors.forename: Gil
authors.initials: G
authors.lastname: Zalsman
authors.forename: Yung-yu
authors.initials: YY
authors.lastname: Huang
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000134:cerebrospinal fluid* / Q000453:epidemiology*; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid*; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid*; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000134:cerebrospinal fluid*; D017397:Prefrontal Cortex / Q000378:metabolism; D015995:Prevalence; D011446:Prospective Studies; D013405:Suicide / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
chemical_list: D008734:Methoxyhydroxyphenylglycol; D006897:Hydroxyindoleacetic Acid; D006719:Homovanillic Acid