Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper
Abstract : BACKGROUND:
There has been increasing interest in both suicide-specific diagnoses
within the psychiatric nomenclature and related biomarkers. Because the
Suicide Crisis Syndrome-an emotional crescendo of several interrelated
symptoms-seems to be promising for the identification of individuals at
risk of suicide, the aim of the present paper is to review the putative
biological underpinnings of the Suicide Crisis Syndrome symptoms
(entrapment, affective disturbance, loss of cognitive control,
hyperarousal, social withdrawal).
METHODS:
A PubMed literature search was performed to identify studies reporting a
link between each of the 5 Suicide Crisis Syndrome symptoms and
biomarkers previously reported to be associated with suicidal outcomes.
RESULTS:
Disturbances in the hypothalamic-pituitary-adrenal axis, with
dysregulated corticotropin-releasing hormone and cortisol levels, may be
linked to a sense of entrapment. Affective disturbance is likely
mediated by alterations in dopaminergic circuits involved in reward and
antireward systems as well as endogenous opioids. Loss of cognitive
control is linked to altered neurocognitive function in the areas of
executive function, attention, and decision-making. Hyperarousal is
linked to autonomic dysregulation, which may be characterized by a
reduction in both heart rate variability and electrodermal activity.
Social withdrawal has been associated with oxytocin availability. There
is also evidence that inflammatory processes may contribute to
individual Suicide Crisis Syndrome symptoms.
CONCLUSION:
The Suicide Crisis Syndrome is a complex syndrome that is likely the
consequence of distinct changes in interconnected neural,
neuroendocrine, and autonomic systems. Available clinical and research
data allow for development of empirically testable hypotheses and
experimental paradigms to scrutinize the biological substrates of the
Suicide Crisis Syndrome.