자살행동의 소인과 생물학적 인자의 관련
Association of Diathesis and Biological Factors in Suicidal Behavior
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자살의 병태생리를 이해하거나 자살을 예측하기 위한 신경생화학적 연구 결과들은 아직은 제한적이고 일관되지 못하다. 이는 인간의 중추신경계가 복잡하고 자살 행동이 복합적인 요인에 의하여 영향을 받기 때문에 자살에 대해 체계적으로 연구하는데 많은 장애가 있기 때문이다. 지금까지의 연구들을 정리하면, 자살 행동은 세로토닌계의 기능 부전과 시상하부-뇌하수체-부신축의 과활성과 관련이 있음을 알 수 있다. 도파민계의 변화나 콜레스테롤의 저하 등은 세로토닌 활성 감소에 인한 변화이거나 세로토닌계의 기능 부전을 취약하게 하는 요인으로 설명될 수 있을 것이다. 시상하부-뇌하수체-부신축의 과활성은 노프아드레날린계의 과활성 및 결핍을 유발하게 된다. 이와 같은 스트레스 반응에 의하여 면역 반응 또는 싸이토카인의 균형에 변화가 일어나고, nitro oxide 또는 BDNF 등의 활성에도 변화가 유발된다. 자살 행동에서 세로토닌 활성의 감소는 주로 전전두엽의 배내측에서 관찰되며, 세로토닌계의 기능 부전과 전전두엽의 배내측의 기능 이상은 충동/공격성을 증가와 관련이 있다. 또한 자살 행동과 관련이 있는 스트레스는 시상하부-뇌하수체-부신축의 과활성 등의 스트레스 반응들을 유발하게 되고, 스트레스가 장기간 지속되거나 스트레스 (반응)에 취약한 사람은 불안이나 우울증 등의 증상을 가지게 되고, 자살 위험이 증가하게 된다. 몇몇 연구자들은 충동/공격성은 자살자의 특성(trait)로, 과도하게 증가된 스트레스 반응을 자살자의 상태(state)로 가정하고, 자살 행동은 이들 특성(trait)와 상태(state)의 상호작용에 의한 것으로 설명한다.3, 67 현재까지의 많은 연구를 통해 우리는 자살과 관련된 정신사회적 인자와 생물학적 인자들을 관찰할 수 있었다. 앞으로의 자살에 대한 연구에서는 보다 포괄적이고 체계적인 연구를 통해서 보다 쉽게 접근할 수 있는 자살의 예측인자들을 찾고, 이를 통해 자살을 치료 및 예방할 수 있는 방법을 찾아야 할 것이다.
Abstract
Suicide is a significant public health issue and a major cause of death throughout the world. There are significant evidences that the activity of 3 neurobiological systems has a role in the pathophysiology of suicidal behavior: a deficiency of serotonergic system, a hyperactivity of the hypothalamic-pituitary-adrenal axis, an excessive release of norepinephrine. These neurobiological abnormalities might correlate with the diathesis of suicide including pessimism and aggression. Dysfunction of the serotonergic system is thought to be associated with disturbances in the regulation of impulsivity and aggression, which may be trait-dependent factor. Hyperactivity of the hypothalamo-pituitary-adrenal axis and excessive activity of the noradrenergic system appear to be involved in the response to stressful events, which may be state-dependent factor. In the future, more understanding several aspect of suicidal behavior and the neurobiology of suicide can help detect better predictor of suicidal behavior and better treatment interventions.
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