Early death and CSF monoamine metabolites in schizophrenia spectrum psychosis

Introduction: Patients with schizophrenia have higher rates of mortality than the general population. Lower concentrations of the cerebrospinal fluid (CSF) monoamine metabolites homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) have been associated with suicidal, aggressive and impulsive behavior. Mortality has been suggested as a measure of impulsivity and a relationship between early death and lower concentrations of CSF monoamine metabolites has been reported but the studies are few with short periods of follow-up and small numbers. Aim: The objective of this study was to investigate a relationship between early death and concentrations of CSF 5-HIAA and HVA. Methods: Three hundred and eighty-five inpatients with schizophrenia spectrum psychosis were lumbar punctured in a standardized manner and followed for a median of 26 years. Patients were searched to identify those who had died. Causes of death were obtained from the Causes of Death Register. Results: During the time of follow-up, 97 patients died. Schizophrenia spectrum psychosis patients died at an earlier age from both natural and unnatural causes of death. No significant associations were found between CSF 5-HIAA and HVA concentrations and non-suicidal death. Attempted suicide was not a risk factor for non-suicidal death at younger age. Conclusion: Patients with schizophrenia spectrum psychosis die at an earlier age from both natural and unnatural causes of death. Attempted suicide is not a risk factor for non-suicidal death at younger age. Low concentrations of CSF HVA and 5-HIAA were not a risk factor for non-suicidal death at younger age in schizophrenia spectrum psychosis.

[1]  P. Pregelj,et al.  Neurobiology of suicidal behaviour. , 2012, Psychiatria Danubina.

[2]  E. Jönsson,et al.  Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis , 2010, Nordic journal of psychiatry.

[3]  E. Jönsson,et al.  CSF 5-HIAA, attempted suicide and suicide risk in schizophrenia spectrum psychosis , 2009, Schizophrenia Research.

[4]  E. Jönsson,et al.  Long-Term Suicide Risk in Schizophrenia Spectrum Psychoses: Survival Analysis by Gender , 2008, Archives of suicide research : official journal of the International Academy for Suicide Research.

[5]  Dianne Currier,et al.  Stress, genes and the biology of suicidal behavior. , 2008, The Psychiatric clinics of North America.

[6]  M. Maj,et al.  Physical illness and schizophrenia: a review of the literature , 2007, Acta psychiatrica Scandinavica.

[7]  S. Saha,et al.  A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time? , 2007, Archives of general psychiatry.

[8]  P. Mortensen,et al.  Increased mortality among patients admitted with major psychiatric disorders: a register-based study comparing mortality in unipolar depressive disorder, bipolar affective disorder, schizoaffective disorder, and schizophrenia. , 2007, The Journal of clinical psychiatry.

[9]  A. Glassman.  Depression and cardiovascular comorbidity , 2007, Dialogues in clinical neuroscience.

[10]  M. Seeman.  An Outcome Measure in Schizophrenia: Mortality , 2007, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[11]  C. Lançon,et al.  Mortality in schizophrenia , 2006, Pharmacoepidemiology and drug safety.

[12]  M. Vares,et al.  Characterization of Patients with Schizophrenia and Related Psychoses: Evaluation of Different Diagnostic Procedures , 2006, Psychopathology.

[13]  J. Thakore.  Metabolic syndrome and schizophrenia. , 2005, The British journal of psychiatry : the journal of mental science.

[14]  M. Vares,et al.  Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses , 2005, Nordic journal of psychiatry.

[15]  P. Sparén,et al.  Excess mortality in schizophrenia in Stockholm County, Sweden , 2003, Schizophrenia Research.

[16]  Maria A Oquendo,et al.  Aggressivity, suicide attempts, and depression: relationship to cerebrospinal fluid monoamine metabolite levels , 2001, Biological Psychiatry.

[17]  E. Arnesen,et al.  Cause-specific mortality in psychiatric patients after deinstitutionalisation , 2001, British Journal of Psychiatry.

[18]  P. Sparén,et al.  Mortality and causes of death in schizophrenia in Stockholm County, Sweden , 2000, Schizophrenia Research.

[19]  M. Åsberg,et al.  Suicide attempts and impulse control disorder are related to low cerebrospinalfluid 5‐HIAA in mentally disorderedviolent offenders , 2000, Acta psychiatrica Scandinavica.

[20]  J. Mann,et al.  Association of aggressive behavior with altered serotonergic function in patients who are not suicidal. , 2000, The American journal of psychiatry.

[21]  J. Birtwistle,et al.  The unhealthy lifestyle of people with schizophrenia , 1999, Psychological Medicine.

[22]  M. Heo,et al.  The distribution of body mass index among individuals with and without schizophrenia. , 1999, The Journal of clinical psychiatry.

[23]  C Waternaux,et al.  Toward a clinical model of suicidal behavior in psychiatric patients. , 1999, The American journal of psychiatry.

[24]  Steve Brown.  Excess mortality of schizophrenia , 1997, British Journal of Psychiatry.

[25]  W. Faustman,et al.  An Association Between Low Levels of 5-HIAA and HVA in Cerebrospinal Fluid and Early Mortality in a Diagnostically Mixed Psychiatric Sample , 1993, British Journal of Psychiatry.

[26]  P. Mortensen,et al.  Mortality and Causes of Death in First Admitted Schizophrenic Patients , 1993, British Journal of Psychiatry.

[27]  M. Linnoila,et al.  CSF serotonin metabolite (5-HIAA) studies in depression, impulsivity, and violence. , 1990, The Journal of clinical psychiatry.

[28]  P. Allebeck,et al.  Suicide and violent death among patients with schizophrenia , 1986, Acta psychiatrica Scandinavica.

[29]  G. Sedvall,et al.  Time Course for Effects of Sulpiride and Chlorpromazine on Monoamine Metabolite and Prolactin Levels in Cerebrospinal Fluid from Schizophrenic Patients , 1984, Acta psychiatrica Scandinavica. Supplementum.

[30]  G. Sedvall,et al.  Aberrant monoamine metabolite levels in CSF and family history of schizophrenia. Their relationships in schizophrenic patients. , 1980, Archives of general psychiatry.

[31]  G. Sedvall,et al.  Effects of melperone and thiothixene on prolactin levels in cerebrospinal fluid and plasma of psychotic women , 1977, Archiv für Psychiatrie und Nervenkrankheiten.

[32]  G. Sedvall,et al.  Effect of chlorpromazine treatment on monoamine metabolite levels in cerebrospinal fluid of psychotic patients , 1977, Acta psychiatrica Scandinavica.

[33]  G. Sedvall,et al.  Monoamine metabolite levels in cerebrospinal fluid of psychotic women treated with melperone or thiothixene , 1977, Archiv für Psychiatrie und Nervenkrankheiten.

[34]  G. Sedvall,et al.  Simultaneous determination of the three major monoamine metabolites in brain tissue and body fluids by a mass fragmentographic method , 1976, Psychopharmacology.

[35]  Annals of General Psychiatry BioMed Central Review , 2005 .

[36]  M. Silverman.  National Strategy for Suicide Prevention: Goals and Objectives for Action. , 2001 .

[37]  G. Sedvall,et al.  Increased frequency of aberrant CSF circulation in schizophrenic patients compared to healthy volunteers , 1996, European Psychiatry.

[38]  Michael F. Green,et al.  in Patients With Schizophrenia , 1994 .

[39]  M. H. Korpel.  [Suicidal behavior of psychiatric patients]. , 1981, Tijdschrift voor ziekenverpleging.