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LETTER TO THE EDITOR
Year : 2016  |  Volume : 13  |  Issue : 3  |  Page : 147-148

Thyroid abnormalities and suicidality in patients with first-episode schizophrenia


Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India

Date of Web Publication27-Oct-2016

Correspondence Address:
Samir Kumar Praharaj
Department of Psychiatry, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.193139

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How to cite this article:
Praharaj SK. Thyroid abnormalities and suicidality in patients with first-episode schizophrenia. Thyroid Res Pract 2016;13:147-8

How to cite this URL:
Praharaj SK. Thyroid abnormalities and suicidality in patients with first-episode schizophrenia. Thyroid Res Pract [serial online] 2016 [cited 2020 Jan 28];13:147-8. Available from: http://www.thetrp.net/text.asp?2016/13/3/147/193139

Sir,

I read with interest the study on the serum thyroid stimulating hormone (TSH) level and suicidality in first-episode schizophrenia patient by Shrivastava et al. [1] in May-August issue of 2016. The authors found 13 out of 60 patients (21%) had attempted suicide 5 days prior to admission. It is estimated that 25-50% of those with schizophrenia attempt suicide, and 4-13% complete suicide in their lifetime. [2],[3] Furthermore, suicide ideation and attempt have been reported in 25.5% and 7.5% of the patients with schizophrenia during the prodromal period. [4]

The severity of suicidality was examined using Scale for Impact of Suicidality-Management, Assessment, and Planning of Care (SIS-MAP) developed by the first author, which classifies the severity into three categories such as mild, moderate, and severe. Moderate to severe level of suicidality was found in 44 out of 60 patients (73%), which is quite high. Interestingly, there were higher proportions of moderate and severe categories among suicide nonattempters than attempters (76% vs. 61%), which appears counterintuitive. The psychopathology scores are also similar among the suicide attempters and nonattempters. It suggests that the instrument SIS-MAP is a poor predictor of the actual attempt, rather than the relief of mental pain that the authors hypothesize. Indeed, in a prospective study, it was shown that the severity of suicidality changes rapidly in patients with schizophrenia, and even mild suicidality predicts severe suicidality, even more than depressed mood. [5]

The rates of elevated TSH were found in approximately 70% of suicide attempters and 60% of nonattempters (the authors have not reported the proportion of elevated TSH in total sample), with TSH cutoff of 5 µIU/ml. Interestingly, the authors had excluded patients with overt thyroid disease from their sample. In contrast, Radhakrishnan et al. [6] had found abnormal thyroid function in 29 out of 108 schizophrenia patients (31.5%), with TSH cutoff values of 0.34-4.1 µIU/ml. In that study, among those with schizophrenia, four patients (3.7%) had hyperthyroidism, therefore, approximately 28% had elevated TSH or clinical/subclinical hypothyroidism, which is less than half that was reported in Shrivastava et al. [1] study. In another large study on schizophrenia patients (n = 769), the mean TSH levels were found to be 1.71 µIU/ml, with abnormal values in 8-22% depending on the cutoff used. [7]

Transient hyperthyroxinemia is known to occur in acute psychiatric illness with elevated levels of free, as well as bound T3 and T4, although it may be paradoxically associated with higher TSH levels, i.e., it is not suppressed despite the elevated levels of thyroid hormones. [8],[9] It is also known that although in the normal range, lower levels of free T4 are reported to be associated with poorer cognitive performance. [10],[11]

The authors report a positive correlation between TSH and suicidality although neither the r value nor the P value was reported. In discussion, they associate higher TSH (in one place they wrongly mention it as lower TSH) with suicidality and state that it confirms association with depression although it was not specifically examined in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shrivastava A, Jadhav V, Karia S, Shah N, De Sousa A. Serum thyroid stimulating hormone levels and suicidal tendency in patients with first-episode schizophrenia: An exploratory study. Thyroid Res Pract 2016;13:63-6.  Back to cited text no. 1
  Medknow Journal  
2.
Meltzer HY. Treatment of suicidality in schizophrenia. Ann N Y Acad Sci 2001;932:44-58.  Back to cited text no. 2
[PUBMED]    
3.
Meltzer HY. Suicidality in schizophrenia: A review of the evidence for risk factors and treatment options. Curr Psychiatry Rep 2002;4:279-83.  Back to cited text no. 3
[PUBMED]    
4.
Andriopoulos I, Ellul J, Skokou M, Beratis S. Suicidality in the "prodromal" phase of schizophrenia. Compr Psychiatry 2011;52:479-85.  Back to cited text no. 4
[PUBMED]    
5.
Young AS, Nuechterlein KH, Mintz J, Ventura J, Gitlin M, Liberman RP. Suicidal ideation and suicide attempts in recent-onset schizophrenia. Schizophr Bull 1998;24:629-34.  Back to cited text no. 5
[PUBMED]    
6.
Radhakrishnan R, Calvin S, Singh JK, Thomas B, Srinivasan K. Thyroid dysfunction in major psychiatric disorders in a hospital based sample. Indian J Med Res 2013;138:888-93.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.
Wysokinski A, Kloszewska I. Level of thyroid-stimulating hormone (TSH) in patients with acute schizophrenia, unipolar depression or bipolar disorder. Neurochem Res 2014;39:1245-53.  Back to cited text no. 7
    
8.
Spratt DI, Pont A, Miller MB, McDougall IR, Bayer MF, McLaughlin WT. Hyperthyroxinemia in patients with acute psychiatric disorders. Am J Med 1982;73:41-8.  Back to cited text no. 8
[PUBMED]    
9.
Roca RP, Blackman MR, Ackerley MB, Harman SM, Gregerman RI. Thyroid hormone elevations during acute psychiatric illness: Relationship to severity and distinction from hyperthyroidism. Endocr Res 1990;16:415-47.  Back to cited text no. 9
[PUBMED]    
10.
Barbero JD, Gutiérrez-Zotes A, Montalvo I, Creus M, Cabezas Á, Solé M, et al. Free thyroxine levels are associated with cognitive abilities in subjects with early psychosis. Schizophr Res 2015;166:37-42.  Back to cited text no. 10
    
11.
Labad J, Barbero JD, Gutiérrez-Zotes A, Montalvo I, Creus M, Cabezas Á, et al. Free thyroxine levels are associated with cognitive changes in individuals with a first episode of psychosis: A prospective 1-year follow-up study. Schizophr Res 2016;171:182-6.  Back to cited text no. 11
    




 

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