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| __NOTOC__
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| {{Suicidal ideation}}
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| {{CMG}}; {{AE}} {{Vbe}}
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| ==Overview==
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| It is thought that [[suicidal]] ideation is caused by decreased expression of [[serotonin]] transporter [[gene]], studies have shown that there is decreased expression of 5 HTT(SLC6A4 gene) in [[Prefrontal cortex|prefronta]]<nowiki/>l and [[Cortical T ALL|cortical]] region. [[MAO-A|MAO]] and [[MAOB]] have also been implicated.
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| ==Pathophysiology==
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| Decreased [[cerebrospinal fluid]] (CSF) [[serotonin]] levels and [[serotonin]] receptor dysfunction are strong risk factors for [[suicide attempt]] and completion. Dysfunction in central [[serotonin]] systems is associated with a lowered threshold for self-directed and externally directed aggressive behavior. In 1976, As berg et al reported a bi-modal distribution of serotonin metabolites (5-HIAA) in the CSF of [[Depressed mood|depressed]] patients.In this study, significantly more of the [[Depressed mood|depressed]] patients in the "low" CSF 5-HIAA group had attempted [[suicide]] compared to the "high" CSF group. A five-year follow-up study of [[Depressed Mood|depressed]] patients concluded that patients who attempted [[suicide]] before the index admission and who reattempted suicide during the follow-up had significantly lower CSF levels of [[5-HIAA]].To date, more than 20 studies have reported low concentrations of CSF 5-HIAA in suicide attempters with a broad range of diagnoses, making this one of the strongest findings in biological [[psychiatry]]. The absolute reduction in the concentration of CSF 5-HIAA appears to correlate well with lethality, increased planning, and medical damage of the suicide attempt.The [[pharmacotherapy]] of [[suicidal]] patients often aims at increasing [[serotonin]] availability in the [[brain stem]].
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| ==Genetics==
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| *[[Genes]] involved in the [[pathogenesis]] of [[suicidal]] ideation include SKA 2 DNA [[methylation]], which has been seen in multiple cohorts. <ref name="pmid26305478">{{cite journal |vauthors=Kaminsky Z, Wilcox HC, Eaton WW, Van Eck K, Kilaru V, Jovanovic T, Klengel T, Bradley B, Binder EB, Ressler KJ, Smith AK |title=Epigenetic and genetic variation at SKA2 predict suicidal behavior and post-traumatic stress disorder |journal=Transl Psychiatry |volume=5 |issue= |pages=e627 |year=2015 |pmid=26305478 |pmc=4564560 |doi=10.1038/tp.2015.105 |url=}}</ref>
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| ==Associated Conditions==
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| The following conditions are associated with increased risk of [[suicidal]] ideation:
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| * [[ Major depressive disorder]]
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| *[[Bipolar disorder]]
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| *[[Schizophrenia]]
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| *[[Post traumatic stress disorder]]
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| *[[Anxiety]]
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| *[[Personality disorders]]
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| ==References==
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| {{Reflist|2}}
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| {{WH}}
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| {{WS}}
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