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Transcranial sonography of the brainstem raphe: A rapid tool to assess the long-term risk of violent suicidal behavior in patients with major depression.

J Affect Disord · 2026-01-10

DOI: 10.1016/j.jad.2026.121175PMID: 41525941

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Research overview

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ObjectiveTo assess the relationship between ultrasonographic changes in midbrain structures and subsequent violent suicidal behavior.MethodsWe 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.ResultsAt 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 ConclusionsReduced echogenicity of the midbrain raphe indicates an increased risk of subsequent violent suicidal behavior in patients with major depression.

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