Electroencephalographic Correlates of Suicide Ideation and Attempts

Struve, Frederick A.; Klein, Donald F.; Saraf, Kishore R.

doi:10.1001/archpsyc.1972.01750270067010

Cited by 27 publications

(11 citation statements)

References 20 publications

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“…However, one of the earliest pioneering studies on physiological determinants of suicide reported a strong positive association between paroxysmal EEG disturbances and suicidal ideation, suicidal ideation and attempts, and assaultive-destructive behaviour (Struve et al 1972). The authors hypothesised that the paroxysmal EEG disturbance did not directly create the suicidal ideation, but may have led to an enhanced vulnerability to impairments in impulse control and planning (ability to reject suicidal thoughts).…”

Section: Alterations In Eeg Activitymentioning

confidence: 99%

Antidepressant Drugs and the Emergence of Suicidal Tendencies

1993

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Although antidepressant medications represent the cornerstone of treatment for patients with moderate to severe clinical depression, they also carry serious risks. There is evidence which suggests that antidepressants can, in rare instances, induce or exacerbate suicidal tendencies. Nine clinical mechanisms have been proposed through which this may occur. These are: (a) energizing depressed patients to act on pre-existing suicidal ideation; (b) paradoxically worsening depression; (c) inducing akathisia with associated self-destructive or aggressive impulses; (d) inducing panic attacks; (e) switching patients into manic or mixed states; (f) producing severe insomnia or interfering with sleep architecture; (g) inducing an organic obsessional state; (h) producing an organic personality disorder with borderline features; and (i) exacerbating or inducing electroencephalogram (EEG) or other neurological disturbances. Epidemiological and controlled studies also provide data on the association between antidepressant drugs and suicidal ideation, attempts and fatalities. These include studies which: (a) suggest that electroconvulsive therapy may be more effective than antidepressant drugs in reducing the frequency of suicide attempts; (b) indicate that antidepressants may differ in their capacity to reduce the frequency of suicide attempts; (c) find that more overdose attempts were made by patients receiving maprotiline than placebo; and (d) suggest that fluoxetine may be associated with a greater risk of inducing de novo suicidal ideation. Evidence suggests that antidepressants may vary by at least 15-fold in the number of fatal overdoses per million prescriptions. Estimated overdose proclivity rates were derived after adjusting the fatal toxicity data by the therapeutic index of the drug. These rates were very consistent between agents with the same pharmacological properties, and correlated well with known overdose risk rates for amitriptyline, mianserin and maprotiline. Estimated overdose proclivity rates suggest that the highly selective noradrenaline (norepinephrine) uptake inhibitors (desipramine, nortriptyline, maprotiline) may be associated with a greater risk for overdose than more mixed uptake inhibitors and monoamine oxidase inhibitors (MAOIs). Antidepressants are not uniformly neutral in regard to suicidal ideation and attempts. Data clearly demonstrate that antidepressants ameliorate suicidal ideation more effectively than placebo in patients with depression. Although antidepressants diminish suicidal ideation in many recipients, about as many patients experience worsening suicidal ideation on active medication as they do on placebo. Furthermore, at least as many patients attempted suicide on fluoxetine and tricyclic antidepressants as on placebo, and more patients attempted to overdose on maprotiline than placebo. These observations suggest that antidepressants may redistribute suicide risk, attenuating risk in some patients who respond well, while possible enhancing risk in others who respond more poorly.(A...

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Section: Alterations In Eeg Activitymentioning

confidence: 99%

Antidepressant Drugs and the Emergence of Suicidal Tendencies

1993

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“…There have not been many EEG studies on patients with suicidal attempts, with the exception of Struve et al 130 They found a higher incidence of paroxysmal EEG abnor¬ mality among patients with suicidal ideas or attempts as compared to pa¬ tients without these symptoms. MacDonald,77 for example, re¬ ported that 46 of 100 carefully studied consecutively admitted patients for threat to kill gave a history of at¬ tempted suicide.…”

Section: Electroencephalographic Studiesmentioning

confidence: 99%

Clinical Studies

1974

Archives of Neurology

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dalotomy for behavior disorders. Arch Neurol 9: 1-16, 1963. 39. Panksepp J: Effects of hypothalamic lesions on mouse-killing and shock-induced fighting in rats. Physiol Behav 6: 311-316, 1971. 40. Plotnik R, Mir D, Delgado JMR: Aggression, noxiousness, and brain stimulation in unrestrained rhesus monkeys, in Scott JP, Eleftheriou BE (eds): The Physiology of Aggression and Defeat. New York, Plenum Press, 1971, pp 143-221. 41. Renfrew JW: The intensity function and reinforcing properties of brain stimulation that elicits attack. Physiol Behav 4:509-515, 1969. 42. Roberts WW, Kiess HO: Motivational properties of hypothalamic aggression in cats. J Comp Physiol Psychol 58:187-193, 1964. 43. Roberts WW, Steinberg ML, Means LW: Hypothalamic mechanisms for sexual, aggressive and other motivational behaviors in the opossum, Didelphis virginiana. J Comp Physiol Psychol 64:1-15, 1967. 44. Robinson BW, Alexander M, Bowne G: Dominance reversal resulting from aggressive responses evoked by brain telestimulation. Physiol Behav 4:749-759, 1969. 45. Sawa M, et al: Preliminary report on amygdaloidectomy on psychotic patients. Folia Psychiatr Neurol Jap 7:309, 1954. 46. Siegel A, Skog D: Effects of electrical stimulation of the septum upon attack behavior elicited from the hypothalamus in the cat. Brain

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“…Their published analysis indicated only a statistical trend ( p < .10) linking ratings of “impulsively suicidal behavior” to EEG abnormality. However, their EEG classification allowed reanalysis of their published data in a way that matched our own methods of EEG analyses (Struve et al, 1972, 1977). We reanalyzed their findings by contrasting their paroxysmal EEG patients against normal and nonparoxysmal EEGs lumped together; when this was done, we found that “impulsively suicidal behavior” was significantly related to presence of paroxysmal EEG dysrhythmia ( p = .03).…”

Section: Eeg and Suicide Among Psychiatric Patientsmentioning

confidence: 99%

“…In our first study (Struve et al, 1972), we employed retrospective clinical chart reviews rather than direct patient interviews. The clinical records of 219 consecutively admitted psychiatric patients aged 15 to 25 were reviewed by two specially trained research psychologists who had no knowledge of EEG findings and who also had no knowledge that they were even participating in a study of EEG–suicide relationships.…”

Section: Eeg and Suicide Among Psychiatric Patientsmentioning

confidence: 99%