Metabolic alterations in patients with self-inflicted aggressive behaviour

Abstract: Self-inflicted aggressive behaviour is a cross diagnostic phenomenon of major clinical relevance in psychiatric setting. Accumulating evidence speaks for a role of metabolic and immunological factors in aggressive behaviour. The aim of this thesis is to enlighten the role of leptin, insulin, glucagon, glucose and IL-1beta in the context of self-inflicted aggressive behaviour. We used cerebrospinal fluid (CSF-) samples from patients with a recent suicide attempt and plasma samples from a five-hour oral glucose tolerance test (OGTT) in women with deliberate self-harm and healthy controls. The main results from the different papers were: I. Women with a recent suicide attempt and major depression have decreased CSF- leptin compared to those with other diagnoses. II. Patients using a violent method for attempting suicide have higher CSF-insulin than those using a non-violent method. III. Women with deliberate self-harm without an eating disorder have low plasma glucose nadir during the OGTT. In those with an eating disorder the low plasma glucose is counteracted by an increased glucagon secretion. IV. Patients with a recent suicide attempt have increased CSF-IL-1beta compared to healthy controls, and the most pronounced elevations are found in patients with Cluster B personality disorder. Women with deliberate self-harm have increased secretion of IL-1beta during the OGTT compared to healthy controls. Our findings support the hypothesis of deviant metabolic and immunological components in self-inflicted aggressive behaviour. Future studies are required to further understand the mechanisms of these components, which may open up the development of new treatments for self-inflicted aggression.