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Background: This study employed an alternative method for assessing serotonergic function to further evaluate our finding that cerebrospinal fluid (CSF) 5-hydroxyindole acetic acid (5-HIAA) in depressed suicide attempters with a lifetime history of higher lethality suicide attempts is significantly lower compared to depressed patients who have a history of low lethality suicide attempts.Method: We used dl-fenfluramine (60 mg) as a neuroendocrine probe to examine the serotonin system in 41 in-patients with a DSM-III-R major depressive episode, divided into two groups on the basis of a lifetime history of high or low lethality suicide attempts. Fenfluramine challenge test outcome was defined as the maximum prolactin response in the five hours following fenfluramine.Results: Patients with a history of a higher lethality suicide attempt had a significantly lower prolactin response to fenfluramine, even when controlling for cortisol, age, sex, weight, comorbid cluster B personality disorder, pharmacokinetic and menstrual cycle effects.Conclusions: The data provide further support for the hypothesis that serotonin dysfunction is associated with more lethal suicide attempts, and suggests that higher lethality suicide attempters or failed suicides resemble completed suicides both behaviourally and biochemically. [ABSTRACT FROM AUTHOR]

Suicide is a major public health issue of global concern. It is the leading cause of death in young Irish men, marking suicide and suicidal behaviour as important topics for clinical epidemiology and public health research. Ireland has a statutory obligation from the "Reach Out" policy document to "systematically plan research into suicidal behaviour to address deficits in our knowledge" (pp. 50). Suicide is undoubtedly a complex phenomenon and therefore one which requires advanced methods of investigation and innovative approaches to research the factors underpinning suicide in modern Ireland, the development and evaluation of prevention strategies and the informing of evidence-based policy.

Behavioural and interpersonal difficulties arising during the course of cognitive psychotherapy are common and they provide unique opportunities to assess and modify patients' beliefs and assumptions. A breakdown in the therapeutic relationship may be on a continuum from a simple misunderstanding to a more chronic and complex problem. It may act as a potent vehicle for change in the patient, but may also precipitate change in the therapist who is also part of that relationship which can influence treatment outcome.