Suicide as an indicium of biologically-based brain disease

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Abstract
Neurobiological evidence indicates that more than mood disorders, impulsive self-directed and other-directed violence and associated behaviors resistent to impulse control are biologically based and associated with alterations in serotonin metabolism. Serotonergic mechanisms are involved with sexual drive, affect, and fight or flight behavior (Linnoila et al., 1983; Traskman-Bendz et al., 1990) which at times may manifest itself as impulsive and be self-destructive. Serotonergic aberrations have been reported with assaults, rape, and eating disorders, in addition to suicides and homicides (Cohen et al., 1988). Schizophrenia, obsessive-compulsive disorder and panic disorder, is also reported associated with serotonergic dysfunction (Vander Kar, 1990). Many healthy people without evidence of psychiatric disorder show a decrease in CSF-5–HIAA (Asberg et al., 1990). supporting a multifactorial concept of suicide. In addition to the biogenetic vulnerably evinced in indoleamine metabolism, situational (e.g., stress, life events, lack of social support, severe illness, reversal of fortune), existential (e.g., angst), and psychological (e.g., early loss, hopelessness), play roles in compelling a person to take his or her own life (Asberg et al., 1990). The reduction of suicidal and impulsive behaviors, such as homicide and rape, requires a coordinated treatment plan involving psychopharmacotherapy, psychotherapy, and socio-therapy (Slaby, 1993). It is the challenge of researchers in suicide to identify which interventions are critical for managing patients with these disorders.