Team 2 : Suicidal behaviour

Philippe Courtet, Sébastien Guillaume* *Co-Directeur de l'unité

France has one of the world's highest suicidal rates (7th in the EU), a fact often ignored. With approximately 200,000 suicide attempts per year and 10 500 deaths, suicide is the second leading cause of death for 15-45 year-olds. The context is almost always linked with psychiatric disorder (depression, schizophrenia, eating disorder, ...) or environmental stress (alcoholism, abuse, exclusion, ...), but these conditions are not sufficient. We aim to identify those subjects with a specific vulnerability to suicidal behaviour (SB) likely to take action, when exposed to a negative environment (stress, exclusion, abuse ...) . In this model, suicide is no longer conceived as a consequence of a more general state, but as an independent entity. A better understanding of this vulnerability should allow the physician to assess the suicidal risk of patients regardless of pathology. Our research focuses on identifying biomarkers and mechanisms at the origin of the vulnerability to SB. We have observed an association between genes coding for proteins involved in the serotoninergic system, with SB and notably specific SB subtypes (violence, recidivism). However, the literature reports conflicting results, particularly because of the clinical and genetic heterogeneity of SB. It is therefore essential to confirm these results and to clarify the exact association between genetic markers tested and SB (Genesis study) . Other research involves the exploration of a potential endophenotype of suicide (decision making) and we are the first to have demonstrated its role through functional imaging of anatomical abnormalities (ventromedial prefrontal cortex) in emotional regulation as well as in decision making involved in SB (fMRI study of vunerability to SB) . The team is now involved in the identification of other potential endophenotypes of SB, such as pain hypersensitivity and social exclusion (Vasco project). The study of the relationship between personality dimensions and cognitive and genetic polymorphisms is currently being conducted on a general population cohort (ESPRIT study). This has enabled us to detect possible impaired interhemispheric brain connectivity in suicide attempters (atrophy of the posterior part of the corpus callosum). We also developed collaborative European research networks: - EURECA (EUropean REsearch CArtel-Suicide): pathophysiology of SB. - network supported by the ECNP (European College of Neuropsychopharmacology): pharmacogenomics of suicidal risk during antidepressant treatment in young depressed people. Other major psychiatric disorders studied: Eating disorders : Our research is identifying neuropsychological impairments associated with anorexia nervosa and bulimia and investigating the link between SB and anorexia nervosa. We are also investigating the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) in bulimia nervosa. Bipolar Disorders : The team is a member of a National Network of Expert Centers in Bipolar disorder established by the foundation Fondamental. The network enables us to follow-up large cohorts of patients with standardized evaluation. Smoking cessation : We are involved in several projects aiming at identifying prognostic factors for smoking cessation using neuropsychological, genetics and clinical assessments, and in a project investigating the therapeutic effect of physical activity on smoking abstinence.

Psychiatrist Professor

Psychiatrist Professor

Psychiatrist Hospital Practitioner

Psychiatrist Ph D Student

Psychologist Post-doctoral Research Fellow

Contact:

Psychologist, Research Assistant Inserm

Biologist Hospital Personnel

Research Assistant Hospital Personnel

Research Assistant Hospital Personnel

Pharmacy Intern and PhD Student

Contact:

Statistician and Epidemiologist Senior Research Assistant Inserm

Research Assistant Hospital Personnel

Biostatistician Hospital personnel

Publications: 

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 Mar 8.
Adida M, Jollant F, Clark L, Besnier N, Guillaume S, Kaladjian A, Mazzola-Pomietto P, Jeanningros R, Goodwin GM, Azorin JM, Courtet P. Trait-Related Decision-Making Impairment in the Three Phases of Bipolar Disorder. Biol Psychiatry. 2011 Mar 21.
Cyprien F, Courtet P, Malafosse A, Maller J, Meslin C, Bonafé A, Le Bars E, Menjot de Champfleur N, Ritchie K, Artero S. Suicidal behavior is associated with reduced corpus callosum area. Biol Psychiatry (In press).
Guillaume S, Sang CN, Jaussent I, Raingeard I, Bringer J, Jollant F, Courtet P. Is decision making really impaired in eating disorders? Neuropsychology. 2010 Nov;24(6):808-12.
Lopez-Castroman J, Perez-Rodriguez MD, Jaussent I, Alegria AA, Artes-Rodriguez A, Freed P, Guillaume S, Jollant F, Leiva-Murillo JM, Malafosse A, Oquendo MA, de Prado-Cumplido M, Saiz-Ruiz J, Baca-Garcia E, Courtet P; European Research Consortium for Suicide (EURECA). Distinguishing the relevant features of frequent suicide attempters. J Psychiatr Res. 2010 Nov 3.
Olie E, Guillaume S, Jaussent I, Courtet P, Jollant F. Higher psychological pain during a major depressive episode may be a factor of vulnerability to suicidal ideation and act. J Affect Disord. 2010 Jan;120(1-3):226-30.
Jollant F, Lawrence NS, Giampietro V, Brammer MJ, Fullana MA, Drapier D, Courtet P, Phillips ML. Orbitofrontal cortex response to angry faces in men with histories of suicide attempts. Am J Psychiatry. 2008 Jun;165(6):740-8.
A Jollant F, Bellivier F, Leboyer M, Astruc B, Torres S, Verdier R, Castelnau D, Malafosse A, Courtet P. Impaired decision making in suicide attempters. Am J Psychiatry. 2005. Feb;162(2):304-10.
Courtet P, Picot MC, Bellivier F, Torres S, Jollant F, Michelon C, Castelnau D, Astruc B, Buresi C, Malafosse A. Serotonin transporter gene may be involved in short-term risk of subsequent suicide attempts. Biol Psychiatry. 2004 Jan 1;55(1):46-51.
Courtet P, Baud P, Abbar M, Boulenger JP, Castelnau D, Mouthon D, Malafosse A, Buresi C. Association between violent suicidal behavior and the low activity allele of the serotonin transporter gene. Mol Psychiatry. 2001 May;6(3):338-41.