Suicide is a dangerous clinical event causing 2% of human mortality. Due to its inherent danger to life and complexity, suicide studies are in high demand. Many resources have been allocated to the development of predicting suicides, its prevention and useful medical interventions so that biomedical and scientific study of the subject is indispensable. Historically, knowledge on suicide was largely based on mental illness studies. The diagnosis of suicide,mood disorders and the treatments have been reported since over 2000 years ago (Hippocrates in 460-377, BC). Despite a long history of association between suicide and mood disorder, the related terminology have evolved greatly. Yet, mortality reduction has been minimal despite many diagnostic and therapeutic studies and no effective therapeutic means have been developed. To improve on this scenario, we review the history and literature on suicide.
Suicide is a dangerous and complex event causing 2% of human mortality[
Multiple different factors can lead to emergency situations with human suicide including environmental (external) and viral, drug or genetic factors (internal)[
The diagnosis and treatment of suicide and mood disorders go back by more than 2000 years (Hippocrates in 460-377 BC)[
Historic order of knowledge of mood disorder discovery (suicide associated)[
Timeline | Major discovery |
---|---|
Ancient Greece | Four elements and melancholy (excess of black bile) |
Aretaeus of cappadocia | Clinical features of depression |
Middle age | Patients with delusion |
16th to 17th | Clinical diagnosis and abnormal behavior |
18th | Nervous (animal spirits) |
19th | Psychiatric symptoms |
20th | Mood disorder, electroplexy and psychosurgery |
Human suicide has been reported for more than 3000 years for social knowledge. In ancient Greece, Egypt and Rome, suicide was not allowed and regarded as sinful. The victims’ bodies would be abandoned in the wilderness and left to animals[
Worldwide, the statistics on human suicide are highly varied between countries such as Latin America[
The causal factors of human suicide are arguable and remain widely disagreed. Currently, neuropsychiatric factors are recognized as one of the main culprits for human suicide events and mortality[
The associations between suicide and other diseases[
Worldwide; total of 15,629 cases | UK; total of 4,859 cases | ||
---|---|---|---|
Mood disorders
|
35%
|
Mood disorders
|
42%
|
Other disorders | 14% | Other disorders | 11% |
From a diagnostic aspect, the symptoms for risk of human suicide (feeling of hopelessness, self-blame and so on) are similar to those of mood disorders (hopelessness and helplessness). The external insults of the environment are also identical to factors behind mood disorders, including marriage problems and the loss of jobs or family members.
As there have yet to be any conclusive outcome on the pathogenesis of suicide, high-quality biomedical studies (genetic, molecular and cerebral imaging) are currently utilized for suicide prediction, prevention and therapeutics[
Mood disorders are an old and serious type of disease. In an ancient discovery, it was first noticed and described by ancient Greek physicians more than 2000 years ago (Hippocrates, 460-377 BC)[
The quest for a relationship between suicide and mental illness has lasted from ancient times to the modern era. Despite the long history of suicide and mental illness studies, diagnostics are especially limited - act and symptoms (suicide attempts and repeats) and is a current area of research emphasis[
Formally, diagnostic guidelines have been established and widely applied worldwide. Detailed diagnostic information can be found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) from DSM-I to DSM-V of mental problems and the Hamilton Depression Rating Scale (HAM-D) of suicide risk.
Psychiatric analysis is currently used as diagnostic means by clinicians and psychiatrists. Medications are prescribed after analyzing the patient’s psychiatric condition (different types of psychiatric illness scoring systems for depressive or manic symptoms) rather than the patient’s genetic predisposition such as pharmacogenetics (PG), genomic sequencing, bioinformatic profiling or brain image/visual comparisons. They analyze patients through disease symptoms (suicide episodes) that mask the most important parts of disease origination and progress (genetic/molecular-based causalities) in a series of pathogenesis stages or suicide-induced mortality. Over the long history of suicide and mental illness studies, quick and proper diagnosis is key. More recently, the morphological or visual scan of human brains of patients at high suicide risk have begun to emerge for determining disease progression or multi-factorial etiological identification[
The genetic changes in psychiatric diseases are enormous, such as UNC13A, NFASC, PTPRG, ERBB2, GR1N2A, HTR2A, DLG, ACTN, MYH9 and many others[
Antidepresssants have been implicated as inducers of human suicide and has been reported with mechanistic investigation. We have previously studied and discussed drug toxicity from a genetics perspective. Our proposition is that some patients with genetic deficiencies may develop an over-reaction to antidepressants and induce human suicide[
To provide a high-quality platform for human suicide study, neuropathic processes may be understood[
Therapeutic studies for neuropsychiatric diseases have increased greatly. Possible therapeutic and drug design pathways are given in
Therapeutic and drug design development
Apart from drug treatment, other types of therapies, such as light therapy (physical treatment) are also useful for mood disorders or suicidal patients[
There are several future directions for optimizing genetic/molecular-based diagnostics for suicide prediction and prevention. From these efforts, a patient’s suicide risk may be quickly understood via high throughput and low cost diagnostics. Targeted drug therapeutics or other types of specific, highly effective interventions can then be clinical implemented
Evolution of diagnostics in suicide and mental disorders[
(1) Scientific testing, scoring and computational networks for clinical data relationship buildup between disease causalities, progression, mortality and possible drug targeting;
(2) Comparisons of different scoring algorithms or calculation systems and customization of several workable paradigms for future clinical personalized medicine application;
(3) Establishment of the relationship between clinical diagnosis and treatment via modern technique-based ways (from genetic to molecular to visual or from visual to molecular or genetics);
(4) Increasing the accumulation of clinical genetic or molecular data (>5000 clinical cases between patients at high suicide risk and normal persons);
(5) Collecting and evaluating data from the diagnostic relationship between genetic polymorphisms, chemical and environmental factors of multiple disciplines[
The prediction and prevention of human suicide, especially in diagnostics, must be greatly promoted and improved. Much work is still needed in the clinic, including clinical diagnosis and effective, targeted drugs for the safeguarding of patients at high suicide risk.
Article writing: Lu DY, Cao S
Data collection and analysis: Wu HY, Che JY
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All authors declared that there are no conflicts of interest.
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© The Author(s) 2020.