Decreased corticotropin-releasing hormone (CRH) concentrations in the cerebrospinal fluid of eucortisolemic suicide attempters

Several lines of evidence suggest a dysregulation of the adrenocortical (HP A) system with hypersecretion of CRH is associated with suicidal behavior. However, controversial results have emerged from the determination of corti cotropin-releasing hormone (CRH) concentrations in the lumbar cerbrospinal fluid (CSF) of suicide attempters probably due to methodological difference s. We simultaneously measured CRH concentrations in the CSF and in the plas ma of 41 psychiatric in-patients with different diagnoses (affective disord er, schizophrenia, personality disorders, adjustment disoder. substance abu se) and eight neurological control subjects. We also measured plasma cortis ol concentrations because: data from animal experiments suggest that cortis ol may influence CSF CRH concentrations. The major finding was that patient s who attempted suicide prior to admission had significantly lower CSF CRH concentrations than psychiatric patients without suicidal behavior. CRH con centrations were significantly higher in the CSF than in plasma in both, ps ychiatric patients and neurological control subjects. There was no signific ant difference between suicide attempters and patients with acute suicidal ideations. The latter group showed a trend towards lower CSF CRH concentrat ions compared with the neurological control subjects. Patients: with affect ive disorder alone as well as patients with multiple diagnoses, but not sch izophrenic patients, showed significantly lower CSF CRH concentrations: tha n neurological control subjects. Plasma CRH and plasma cortisol concentrati ons did not differ among diagnostic groups or between suicide attempters vs . non-attempters. Further studies with more homogenous samples, drug-free p atients and with simultaneous assessment of various parameters of the HPA s ystem are warranted. (C) 2001 Elsevier Science Ltd. All rights reserved.