When Sick Brain and Hopelessness Meet: Some Aspects of Suicidality in the Neurological Patient

Author(s): Alessandra Costanza*, Andrea Amerio, Andrea Aguglia, Andrea Escelsior, Gianluca Serafini, Isabella Berardelli, Maurizio Pompili, Mario Amore

Journal Name: CNS & Neurological Disorders - Drug Targets
Formerly Current Drug Targets - CNS & Neurological Disorders

Volume 19 , Issue 4 , 2020


Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Abstract:

Neurological diseases expose individuals to a higher risk of suicidal ideation and suicidal behavior, including completed suicides and suicide attempts. They also represent a paradigmatic arena to study the etiopathogenic mechanisms underlying suicidality because they are emblematic of the heterogeneity and complexity of mutual interrelationships characterizing this issue. On the one hand, neurological diseases imply strictly biological impairments that are postulated to be the basis of vulnerability to suicide or result in the need for treatments for which a suicidal risk has been hypothesized. On the other hand, they question some subjective experiences of neurological patients, up to near existential positions. Often, in fact, they are accompanied by severe hopelessness. The latter may originate in, particularly for the most severe neurological diseases, the absence of curative treatments, unpredictable disease progression that leads to acute relapses or chronicity, a decrease in autonomy or selfidentity, progressive social isolation, a sense of becoming useless, and perception of feeling stigmatized. This may ultimately cause a slip into experiencing an absurd condition. At the confluence of neurobiology and hopelessness, frequent psychiatric comorbidities may play a primary role. To conclude, neurological patients require special attention from clinicians in form of openly verbalizing and exploring the suicidal thematic, inquiring about protective and risk factors, and promptly initiating both a psychopharmacological treatment and, where possible, psychological support.

Keywords: Suicidal behavior, suicide, suicide attempt, suicidal ideation, neurologic diseases, hopelessness.

[1]
Arciniegas DB, Anderson CA. Suicide in neurologic illness. Curr Treat Options Neurol 2002; 4(6): 457-68.
[http://dx.doi.org/10.1007/s11940-002-0013-5] [PMID: 12354372]
[2]
Coughlin SS, Sher L. Suicidal behavior and neurological illnesses. J Depress Anxiety 2013; 9(1): 12443.
[3]
Eliasen A, Dalhoff KP, Horwitz H. Neurological diseases and risk of suicide attempt: a case-control study. J Neurol 2018; 265(6): 1303-9.
[http://dx.doi.org/10.1007/s00415-018-8837-4] [PMID: 29564603]
[4]
Costanza A, Baertschi M, Weber K, Canuto A. Neurological diseases and suicide: from neurobiology to hopelessness. Rev Med Suisse 2015; 11(461): 402-5.
[PMID: 25895218]
[5]
Pompili M, Gibiino S, Innamorati M, et al. Prolactin and thyroid hormone levels are associated with suicide attempts in psychiatric patients. Psychiatry Res 2012; 200(2-3): 389-94.
[http://dx.doi.org/10.1016/j.psychres.2012.05.010] [PMID: 22748186]
[6]
van Heeringen C, Bijttebier S, Godfrin K. Suicidal brains: a review of functional and structural brain studies in association with suicidal behaviour. Neurosci Biobehav Rev 2011; 35(3): 688-98.
[http://dx.doi.org/10.1016/j.neubiorev.2010.08.007] [PMID: 20826179]
[7]
van Heeringen K, Mann JJ. The neurobiology of suicide. Lancet Psychiatry 2014; 1(1): 63-72.
[http://dx.doi.org/10.1016/S2215-0366(14)70220-2] [PMID: 26360403]
[8]
Serafini G, Pardini M, Pompili M, Girardi P, Amore M. Understanding suicidal behavior: the contribution of recent resting-state fMRI techniques. Front Psychiatry 2016; 7: 69.
[http://dx.doi.org/10.3389/fpsyt.2016.00069] [PMID: 27148097]
[9]
Costanza A, D’Orta I, Perroud N, et al. Neurobiology of suicide: do biomarkers exist? Int J Legal Med 2014; 128(1): 73-82.
[http://dx.doi.org/10.1007/s00414-013-0835-6] [PMID: 23430141]
[10]
Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a 10-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry 1985; 142(5): 559-63.
[http://dx.doi.org/10.1176/ajp.142.5.559] [PMID: 3985195]
[11]
Williams M. Suicide and attempted suicide: understanding the cry of pain. London: Penguin Books 2002.
[12]
Hsiao JJ, Kaiser N, Fong SS, Mendez MF. Suicidal behavior and loss of the future self in semantic dementia. Cogn Behav Neurol 2013; 26(2): 85-92.
[http://dx.doi.org/10.1097/WNN.0b013e31829c671d] [PMID: 23812172]
[13]
Rickards H. Depression in neurological disorders: an update. Curr Opin Psychiatry 2006; 19(3): 294-8.
[http://dx.doi.org/10.1097/01.yco.0000218601.17722.5b] [PMID: 16612216]
[14]
Kachian ZR, Cohen-Zimerman S, Bega D, Gordon B, Grafman J. Suicidal ideation and behavior in Huntington’s disease: systematic review and recommendations. J Affect Disord 2019; 250: 319-29.
[http://dx.doi.org/10.1016/j.jad.2019.03.043] [PMID: 30875675]
[15]
Burn DJ. Beyond the iron mask: towards better recognition and treatment of depression associated with Parkinson’s disease. Mov Disord 2002; 17(3): 445-54.
[http://dx.doi.org/10.1002/mds.10114] [PMID: 12112190]
[16]
Leentjens AFG, Van den Akker M, Metsemakers JFM, Lousberg R, Verhey FR. Higher incidence of depression preceding the onset of Parkinson’s disease: a register study. Mov Disord 2003; 18(4): 414-8.
[http://dx.doi.org/10.1002/mds.10387] [PMID: 12671948]
[17]
Benoit M, Robert PH. Imaging correlates of apathy and depression in Parkinson’s disease. J Neurol Sci 2011; 310(1-2): 58-60.
[http://dx.doi.org/10.1016/j.jns.2011.07.006] [PMID: 21831400]
[18]
Kostić VS, Filippi M. Neuroanatomical correlates of depression and apathy in Parkinson’s disease: magnetic resonance imaging studies. J Neurol Sci 2011; 310(1-2): 61-3.
[http://dx.doi.org/10.1016/j.jns.2011.05.036] [PMID: 21684552]
[19]
Murai T, Müller U, Werheid K, et al. In vivo evidence for differential association of striatal dopamine and midbrain serotonin systems with neuropsychiatric symptoms in Parkinson’s disease. J Neuropsychiatry Clin Neurosci 2001; 13(2): 222-8.
[http://dx.doi.org/10.1176/jnp.13.2.222] [PMID: 11449029]
[20]
Berardelli I, Belvisi D, Nardella A, et al. suicide in Parkinson’s disease: a systematic review. CNS Neurol Disord Drug Targets 2019; 18(6): 466-77.
[http://dx.doi.org/10.2174/1871527318666190703093345] [PMID: 31269887]
[21]
Berardelli I, Belvisi D, Corigliano V, et al. Suicidal ideation, perceived disability, hopelessness and affective temperaments in patients affected by Parkinson’s disease. Int J Clin Pract 2018; 73: e13287.
[http://dx.doi.org/10.1111/ijcp.13287] [PMID: 30339296]
[22]
Hassan A, Bower JH, Kumar N, et al. Dopamine agonist-triggered pathological behaviors: surveillance in the PD clinic reveals high frequencies. Parkinsonism Relat Disord 2011; 17(4): 260-4.
[http://dx.doi.org/10.1016/j.parkreldis.2011.01.009] [PMID: 21310646]
[23]
Burkhard PR, Vingerhoets FJG, Berney A, Bogousslavsky J, Villemure JG, Ghika J. Suicide after successful deep brain stimulation for movement disorders. Neurology 2004; 63(11): 2170-2.
[http://dx.doi.org/10.1212/01.WNL.0000145603.48221.B5] [PMID: 15596774]
[24]
Voon V, Krack P, Lang AE, et al. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain 2008; 131(Pt 10): 2720-8.
[http://dx.doi.org/10.1093/brain/awn214] [PMID: 18941146]
[25]
Pollak P. Deep brain stimulation for Parkinson’s disease - patient selection. Handb Clin Neurol 2013; 116: 97-105.
[http://dx.doi.org/10.1016/B978-0-444-53497-2.00009-7] [PMID: 24112888]
[26]
Giannini G, Francois M, Lhommée E, et al. Suicide and suicide attempts after subthalamic nucleus stimulation in Parkinson disease. Neurology 2019; 93(1): e97-e105.
[http://dx.doi.org/10.1212/WNL.0000000000007665] [PMID: 31101738]
[27]
Stenager EN, Stenager E. Suicide and patients with neurologic diseases. Methodologic problems. Arch Neurol 1992; 49(12): 1296-303.
[http://dx.doi.org/10.1001/archneur.1992.00530360098025] [PMID: 1449409]
[28]
Pompili M, Forte A, Palermo M, et al. Suicide risk in multiple sclerosis: a systematic review of current literature. J Psychosom Res 2012; 73(6): 411-7.
[http://dx.doi.org/10.1016/j.jpsychores.2012.09.011] [PMID: 23148807]
[29]
Fang F, Valdimarsdóttir U, Fürst CJ, et al. Suicide among patients with amyotrophic lateral sclerosis. Brain 2008; 131(Pt 10): 2729-33.
[http://dx.doi.org/10.1093/brain/awn161] [PMID: 18669498]
[30]
Verschueren A, Kianimehr G, Belingher C, et al. Wish to die and reasons for living among patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20(1-2): 68-73.
[http://dx.doi.org/10.1080/21678421.2018.1530265] [PMID: 30430868]
[31]
Bindler L, Travers D, Millet B. Suicide in Huntington’s disease: a review. Rev Med Suisse 2009; 5(195): 646-8.
[PMID: 19365916]
[32]
Haw C, Harwood D, Hawton K. Dementia and suicidal behavior: a review of the literature. Int Psychogeriatr 2009; 21(3): 440-53.
[http://dx.doi.org/10.1017/S1041610209009065] [PMID: 19368760]
[33]
Alberici A, Cottini E, Cosseddu M, Borroni B, Padovani A. Suicide risk in frontotemporal lobe degeneration: to be considered, to be prevented. Alzheimer Dis Assoc Disord 2012; 26(2): 194-6.
[http://dx.doi.org/10.1097/WAD.0b013e3182223254] [PMID: 21666430]
[34]
Serafini G, Calcagno P, Lester D, Girardi P, Amore M, Pompili M. Suicide risk in Alzheimer’s disease: a systematic review. Curr Alzheimer Res 2016; 13(10): 1083-99.
[http://dx.doi.org/10.2174/1567205013666160720112608] [PMID: 27449996]
[35]
Pompili M, Venturini P, Campi S, et al. Do stroke patients have an increased risk of developing suicidal ideation or dying by suicide? An overview of the current literature. CNS Neurosci Ther 2012; 18(9): 711-21.
[http://dx.doi.org/10.1111/j.1755-5949.2012.00364.x] [PMID: 22943140]
[36]
Recklitis CJ, Diller LR, Li X, Najita J, Robison LL, Zeltzer L. Suicide ideation in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol 2010; 28(4): 655-61.
[http://dx.doi.org/10.1200/JCO.2009.22.8635] [PMID: 19841325]
[37]
Pompili M, Girardi P, Tatarelli G, Angeletti G, Tatarelli R. Suicide after surgical treatment in patients with epilepsy: a meta-analytic investigation. Psychol Rep 2006; 98(2): 323-38.
[http://dx.doi.org/10.2466/pr0.98.2.323-338] [PMID: 16796084]
[38]
Hesdorffer DC, Ishihara L, Webb DJ, Mynepalli L, Galwey NW, Hauser WA. Occurrence and recurrence of attempted suicide among people with epilepsy. JAMA Psychiatry 2016; 73(1): 80-6.
[http://dx.doi.org/10.1001/jamapsychiatry.2015.2516] [PMID: 26650853]
[39]
Pompili M, Serafini G, Innamorati M, et al. Factors associated with hopelessness in epileptic patients. World J Psychiatry 2014; 4(4): 141-9.
[http://dx.doi.org/10.5498/wjp.v4.i4.141] [PMID: 25540729]
[40]
Pack AM. Epilepsy and suicidality: what’s the relationship? Epilepsy Curr 2016; 16(4): 236-8.
[http://dx.doi.org/10.5698/1535-7511-16.4.236] [PMID: 27582659]
[41]
Food and Drug Administration. Memorandum: briefing document for the July 10, 2008 Advisory Committee Meeting to discuss Antiepileptic Drugs (AEDs) and suicidality 2008. Available at http://www.fda.gov/ohrms/dockets/ac/08/briefing/2008-4372b1-01-FDA-Katz.pdf
[42]
Pompili M, Baldessarini RJ. Epilepsy: risk of suicidal behavior with antiepileptic drugs. Nat Rev Neurol 2010; 6(12): 651-3.
[http://dx.doi.org/10.1038/nrneurol.2010.165] [PMID: 21131913]
[43]
Wrench J, Wilson SJ, Bladin PF. Mood disturbance before and after seizure surgery: a comparison of temporal and extratemporal resections. Epilepsia 2004; 45(5): 534-43.
[http://dx.doi.org/10.1111/j.0013-9580.2004.48803.x] [PMID: 15101835]
[44]
Wilson S, Bladin P, Saling M. The “burden of normality”: concepts of adjustment after surgery for seizures. J Neurol Neurosurg Psychiatry 2001; 70(5): 649-56.
[http://dx.doi.org/10.1136/jnnp.70.5.649] [PMID: 11309460]
[45]
Wilson SJ, Bladin PF, Saling MM. Paradoxical results in the cure of chronic illness: the “burden of normality” as exemplified following seizure surgery. Epilepsy Behav 2004; 5(1): 13-21.
[http://dx.doi.org/10.1016/j.yebeh.2003.11.013] [PMID: 14751201]
[46]
Gilbert F. The burden of normality: from ‘chronically ill’ to ‘symptom free’. New ethical challenges for deep brain stimulation postoperative treatment. J Med Ethics 2012; 38(7): 408-12.
[http://dx.doi.org/10.1136/medethics-2011-100044] [PMID: 22431560]
[47]
Péron J. Neuropsychological care of patients undergoing deep brain stimulation in neurology and psychiatry: towards an individualized, integrated approach. Rev Neuropsychol 2016; 8(1): 16-24.
[48]
Baertschi M, Flores Alves Dos Santos J, Burkhard P, Weber K, Canuto A, Favez N. The burden of normality as a model of psychosocial adjustment after deep brain stimulation for Parkinson’s disease: a systematic investigation. Neuropsychology 2019; 33(2): 178-94.
[http://dx.doi.org/10.1037/neu0000509] [PMID: 30667249]
[49]
Costanza A, Prelati M, Pompili M. The meaning in life in suicidal patients: the presence and the search for constructs. a systematic review. Medicina (Kaunas) 2019; 55(8): 465.
[http://dx.doi.org/10.3390/medicina55080465] [PMID: 31405240]
[50]
Costanza A, Baertschi M, Richard-Lepouriel H, et al. The presence and the search constructs of meaning in life in suicidal patients attending a psychiatric emergency department. Front Psychiatry 2020; 11: 327.
[51]
Costanza A, Amerio A, Odone A, et al. Suicide prevention from a public health perspective. What makes life meaningful? The opinion of some suicidal patients. Acta Biomed 2020; 91(3-S): 128-34.
[PMID: 32275277]
[52]
Costanza A, Baertschi M, Richard-Lepouriel H, et al. Demoralization and its relationship with depression and hopelessness in suicidal patients attending an emergency department. Int J Environ Res Public Health 2020; 17(7): 2232.
[http://dx.doi.org/10.3390/ijerph17072232] [PMID: 32225017]


open access plus

Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 19
ISSUE: 4
Year: 2020
Page: [257 - 263]
Pages: 7
DOI: 10.2174/1871527319666200611130804

Article Metrics

PDF: 38
HTML: 5