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Retrospective analysis of quantitative electroencephalography changes in a dissimulating patient after dying by suicide: A single case report

. 2023 ; 14 () : 1002215. [epub] 20230315

Status PubMed-not-MEDLINE Language English Country Switzerland Media electronic-ecollection

Document type Case Reports, Journal Article

We present the case of a 49-year-old man who was diagnosed with depressive disorder, with the first episode having a strong reactive factor. He was involuntarily admitted to a psychiatric hospital after a failed attempt at taking his own life, where he responded to psychotherapy and antidepressant therapy, as evidenced by a >60% reduction in his MADRS total score. He was discharged after 10 days of treatment, denied having suicidal ideations, and was motivated to follow the recommended outpatient care. The risk for suicide during hospitalization was also assessed using suicide risk assessment tools and psychological assessments, including projective tests. The patient underwent a follow-up examination with an outpatient psychiatrist on the 7th day after discharge, during which the suicide risk assessment tool was administered. The results indicated no acute suicide risk or worsening of depressive symptoms. On the 10th day after discharge, the patient took his own life by jumping out of the window of his flat. We believe that the patient had dissimulated his symptoms and possessed suicidal ideations, which were not detected despite repeated examinations specifically designed to assess suicidality and depression symptoms. We retrospectively analyzed his quantitative electroencephalography (QEEG) records to evaluate the change in prefrontal theta cordance as a potentially promising biomarker of suicidality, given the inconclusive results of studies published to date. An increase in prefrontal theta cordance value was found after the first week of antidepressant therapy and psychotherapy in contrast to the expected decrease due to the fading of depressive symptoms. As demonstrated by the provided case study, we hypothesized that prefrontal theta cordance may be an EEG indicator of a higher risk of non-responsive depression and suicidality despite therapeutic improvement.

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Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. . The columbia-suicide severity rating scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. (2011) 168:1266–77. 10.1176/appi.ajp.2011.10111704 PubMed DOI PMC

Kumar D, Nizamie SH, Abhishek P, Prasanna LT. Identification of suicidal ideations with help of projective tests: a review. Asian J Psychiatr. (2014) 12:36–42. 10.1016/j.ajp.2014.07.004 PubMed DOI

Bani-Fatemi A, Tasmim S, Graff-Guerrero A, Gerretsen P, Strauss J, Kolla N, et al. . Structural and functional alterations of the suicidal brain: an updated review of neuroimaging studies. Psychiatry Res Neuroimaging. (2018) 278:77–91. 10.1016/j.pscychresns.2018.05.008 PubMed DOI

Jollant F, Lawrence NL, Olié E, Guillaume S, Courtet P. The suicidal mind and brain: a review of neuropsychological and neuroimaging studies. World J Biol Psychiatry. (2011) 12:319–39. 10.3109/15622975.2011.556200 PubMed DOI

Kopecek M, Sos P, Brunovsky M, Bares M, Stopkova P, Krajca V. Can prefrontal theta cordance differentiate between depression recovery and dissimulation? Neuroendocrinol Lett. (2007) 28:524–6. PubMed

Iosifescu DV, Greenwald S, Devlin P, Perlis RH, Denninger JW, Alpert JE, et al. . Pretreatment frontal EEG and changes in suicidal ideation during SSRI treatment in major depressive disorder. Acta Psychiatr Scand. (2008) 117:271–6. 10.1111/j.1600-0447.2008.01156.x PubMed DOI

Hunter AM, Cook IA, Leuchter AF. The promise of the quantitative electroencephalogram as a predictor of antidepressant treatment outcomes in major depressive disorder. Psychiatr Clin North Am. (2007) 30:105–24. 10.1016/j.psc.2006.12.002 PubMed DOI

Lee SM, Jang KI, Chae JH.:Electroencephalographic correlates of suicidal ideation in the theta band. Clin EEG Neurosci. (2017) 48:316–21. 10.1177/1550059417692083 PubMed DOI

Park Y, Jung W, Kim S, Jeon H, Lee SH. Frontal alpha asymmetry correlates with suicidal behavior in major depressive disorder. Clin Psychopharmacol Neurosci. (2019) 17:377–87. 10.9758/cpn.2019.17.3.377 PubMed DOI PMC

Schiller MJ. Quantitative electroencephalography in guiding treatment of major depression. Front Psychiatry. (2019) 9:1–7. 10.3389/fpsyt.2018.00779 PubMed DOI PMC

Hughes JR, John ER. Conventional and quantitative electroencephalography in psychiatry. J Neuropsychiatry Clin Neurosci. (1999) 11:190–208. 10.1176/jnp.11.2.190 PubMed DOI

Leuchter AF, Cook IA, Lufkin RB, Dunkin J, Newton TF, Cummings JL, et al. . Cordance: a new method for assessment of cerebral perfusion and metabolism using quantitative electroencephalography. Neuroimage. (1994) 1:208–19. 10.1006/nimg.1994.1006 PubMed DOI

Leuchter AF, Uijtdehaage SH, Cook IA, O'Hara R, Mandelkern M. Relationship between brain electrical activity and cortical perfusion in normal subjects. Psychiatry Res. (1999) 90:125–40. 10.1016/s0925-4927(99)00006-2 PubMed DOI

Hunter AM, Leuchter AF, Cook IA, Abrams M. Brain functional changes (QEEG cordance) and worsening suicidal ideation and mood syptoms during antidepressant treatment. Acta Psychiatr Scand. (2010) 122:461–9. 10.1111/j.1600-0447.2010.01560.x PubMed DOI

Roh SC, Kim JS, Kim S, Kim Y, Lee SH. Frontal alpha asymmetry moderated by suicidal ideation in patients with major depressive disorder: a comparison with healthy individuals. Clin Psychopharmacol Neurosci. (2020) 18:58–66. 10.9758/cpn.2020.18.1.58 PubMed DOI PMC

Rakús T, Hubčíková K, Bruncvik L, Pechanová Z, Brunovský M. Electrophysiological correlates of suicidality. Psychiatr Danub. (2021) 33:266–79. 10.24869/psyd.2021.266 PubMed DOI

Montgomery SA, Åsberg M. A new depression scale designed to be sensitive to change. Br J Psychiatry. (1979) 134:382–9. 10.1192/bjp.134.4.382 PubMed DOI

Kendra JM. Predicting suicide using the Rorschach inkblot test. J Pers Assess. (1979) 43:452–6. 10.1207/s15327752jpa4305_1 PubMed DOI

Leuchter AF, Cook IA, Witte E, Morgan M, Abrams M. Changes in brain function of depressed subjects during treatment with placebo. Am J Psychiatry. (2002) 159:122–9. 10.1176/appi.ajp.159.1.122 PubMed DOI

Cook IA, Leuchter AF, Morgan ML, Stubbeman W, Siegman B, Abrams M. Changes in prefrontal activity characterize clinical re-sponse in SSRI nonresponders: a pilot study. J Psychiatr Res. (2005) 39:461–6. 10.1016/j.jpsychires.2004.12.002 PubMed DOI

Bares M, Brunovsky M, Kopecek M, Stopkova P, Novak T, Kozeny J et al. Changes in QEEG prefrontal cordance as a predictor of response to antidepressants in patients with treatment resistant depressive disorder: a pilot study. J Psychiatr Res. (2007) 41:319–25. 10.1016/j.jpsychires.2006.06.005 PubMed DOI

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