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@ARTICLE{Walter:284362,
      author       = {Walter, Uwe and Kaulitz, Lara and Heilmann, Robert and
                      Školoudík, David and Höppner-Buchmann, Jacqueline},
      title        = {{T}ranscranial sonography of the brainstem raphe: {A} rapid
                      tool to assess the long-term risk of violent suicidal
                      behavior in patients with major depression.},
      journal      = {Journal of affective disorders},
      volume       = {399},
      issn         = {0165-0327},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DZNE-2026-00130},
      pages        = {121175},
      year         = {2026},
      abstract     = {To assess the relationship between ultrasonographic changes
                      in midbrain structures and subsequent violent suicidal
                      behavior.We conducted a retrospective analysis of a
                      previously reported cohort of 46 patients (36 women; age
                      54.9 ± 11.7 years) with major depression who had been
                      prospectively observed over a ten-year period to assess the
                      risk of developing Parkinson's disease. At study entry, all
                      patients underwent transcranial B-mode sonography to grade
                      the echogenicity of the midbrain raphe and substantia nigra.
                      The outcome measure was the first occurrence of violent
                      suicidal behavior, i.e. a serious suicide attempt or
                      completed suicide.At baseline, four patients were found to
                      have grade 1 raphe echogenicity (invisible), 23 had grade 2
                      (weakly echogenic), and 19 had normal grade 3 (strongly
                      echogenic). The visually graded echogenicity correlated well
                      with the digitally analyzed echo-intensity (p < 0.001).
                      Three $(75\%)$ patients with echogenicity grade 1
                      subsequently attempted or completed suicide, as did five
                      $(22\%)$ with grade 2, but none with grade 3 (Kaplan-Meier
                      analysis, log-rank test, p < 0.001). The latency period did
                      not differ between echogenicity grade 1 and 2 (34.7 ± 30.9
                      vs. 22.6 ± 19.7 months, p = 0.59). Overall, patients with
                      reduced raphe echogenicity were less likely to be free of
                      subsequent violent suicidal behavior (3 years: RR, 0.78;
                      $95\%$ CI, 0.64-0.95; p = 0.034; 10 years: 0.70; 0.55-0.90;
                      p = 0.014). No sex differences were found. Echogenicity of
                      the substantia nigra did not improve the prediction of
                      suicidal behavior.Reduced echogenicity of the midbrain raphe
                      indicates an increased risk of subsequent violent suicidal
                      behavior in patients with major depression.},
      keywords     = {Humans / Female / Male / Major Depressive Disorder:
                      diagnostic imaging / Major Depressive Disorder: psychology /
                      Middle Aged / Ultrasonography, Doppler, Transcranial /
                      Suicide, Attempted: psychology / Suicide, Attempted:
                      statistics $\&$ numerical data / Retrospective Studies /
                      Raphe Nuclei: diagnostic imaging / Adult / Suicide,
                      Completed: psychology / Suicide, Completed: statistics $\&$
                      numerical data / Aged / Substantia Nigra: diagnostic imaging
                      / Risk Factors / Violence: psychology / Parkinson Disease:
                      diagnostic imaging / Depressive disorder (Other) /
                      Diagnostic ultrasound (Other) / Fatal suicide (Other) /
                      Midbrain raphe (Other) / Substantia nigra (Other) / Suicide
                      prevention (Other)},
      cin          = {AG Storch},
      ddc          = {610},
      cid          = {I:(DE-2719)5000014},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41525941},
      doi          = {10.1016/j.jad.2026.121175},
      url          = {https://pub.dzne.de/record/284362},
}