Neuropsychological factors of suicidal behaviour in persons with alcohol dependence

In the past 20 years, there is increasing evidence that suicidal behaviour has strong neurobiological determinants. The suicide vulnerability is a result of the interaction between triggers (acute psychiatric illness, drugs, adverse life events, family crisis) and predispositions (genetics, personality disorders, alcoholism, decreased serotonin activity, neurobiological deficits) for suicidal behaviour. The above model of suicidal behaviour suggests that a patient must have at least one major risk factor from each domain to be at a high risk for suicide. The lifetime risk of suicide for alcoholics is 11-15%. Regarding the presence of a significant group of alcoholics without suicidal behaviour, new neuropsychological data would enlighten the relationship between alcohol abuse and suicidal behaviour and this might be necessary in distinguishing suicidal from non-suicidal alcoholics.

The aim of the study was to determine those neuropsychological characteristics (predisposition domains) that increase the risk of suicidal behaviour in the group of alcoholics. The hypothesis was that some emotional and cognitive characteristics could determine the suicidal state of mind (cognitive constriction, monosemantic cognitive style, low ability for affect regulation, impulsive behaviour, and depression) due to functional insufficiency of the right hemisphere. Namely, many studies revealed that some neurochemical, structural and functional brain changes may predispose suicidal vulnerability. Moreover, chronic alcohol abuse has been associated with some brain changes like cortical and hippocampal atrophy, cerebellar degeneration, ventricular enlargement, white matter lesions and decreased serotonin activity. So we expected the correlation between insufficiency of the right hemisphere and suicidal vulnerability.

Because of a high incidence of suicidal behaviour (31/100 000 people per year) and alcohol addiction (35-80 000) in Slovenia, the knowledge of neuropsychological characteristics that distinguish suicidal from nonsuicidal alcoholics would help clinicians to find patients who are endangered and include prevention in the therapeutic plan.