Suicide and suicidal ideation in Parkinson's disease

Kostić, Vladimir; Pekmezović, Tatjana; Tomić, Aleksandra; Ječmenica-Lukić, Milica; Stojković, Tanja; Špica, Vladana; Svetel, Marina; Stefanova, Elka; Petrović, Igor; Džoljić, Eleonora

doi:10.1016/j.jns.2009.08.016

Cited by 71 publications

(68 citation statements)

References 34 publications

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“…Suicidal ideation is a core symptom of major depression, and the two are highly associated (Kostic et al, 2010). Hopelessness associated with depression greatly increases suicide risk (Lynch et al, 2008).…”

Section: Risk Factors For Suicidal Ideation In Neurologymentioning

confidence: 99%

Suicide Prevention in Neurology Patients

Lewis

Anderson²,

Feuchtinger³

2014

Journal of Neuroscience Nursing

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Objective This article is an overview of the neurological diagnoses with highest attempt in suicide. The most common risk factors in suicidal ideation in neurology patients are identified, as well as the description of ways to assess and implement treatment of patients with suicidal ideation, including the recommendations for patients with specific neurological diagnosis. A guideline development is needed to address suicide concerns in these patients. Methods A literature search was conducted to find published studies and patient guidelines that were relevant to suicidal ideation, assessment, and treatment in neurology patients. Results Information found was not always exclusively for neurology patients. Findings often discussed psychiatric patients. The neurological diagnosis most associated with suicidal ideation includes multiple sclerosis, epilepsy, and Parkinson’s disease. The most common risk factors for suicidal ideation are hopelessness, depression, and social isolation. As treatment factors, a therapeutic relationship, treatment for depression, assurance of patient safety, and specific interventions for suicidal prevention were identified to provide health care professionals in neurology ways to address suicidal issues for patients with neurological diagnoses. Three protocols highlighted staff prevention activities. Discussion Since patients with neurological disorders experience suicidal ideation with a greater risk of suicide, particularly in multiple sclerosis, epilepsy, and Parkinson’s disease, the potential risk for suicide requires active assessment, monitoring, and intervention by nurses and health professionals to address this clinical issue. The assessments available require further psychometric testing for reliability and validity with patient use. There is a need for more research to develop a guideline/protocol exclusively for neurological patients.

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Section: Risk Factors For Suicidal Ideation In Neurologymentioning

confidence: 99%

Suicide Prevention in Neurology Patients

Lewis

Anderson²,

Feuchtinger³

2014

Journal of Neuroscience Nursing

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“…In our opinion, this is difficult to realize in a condition of apathetic and anhedonic state. Recent studies report a broad range of rates of attempted (1.6% to 4.3%) [1,10] or completed suicides (0.8% to 2%) [2,10] in medically treated groups. In our experience, suicide may be more common in LCIG-treated patients, because we have witnessed 1 (4%) case of suicide among 25 PD patients treated with LCIG from 2012 to 2015 and no suicide observation in 20 years with the traditional oral therapy.…”

Section: Letter To Editormentioning

confidence: 99%

“…Depression is the most common psychiatric disturbance that affects people with PD. On multivariate analysis, severity of depression and psychosis were the only predictors of suicide or death ideation for PD patients [1,2]. Recent reports of an increased suicide risk associated with subthalamic nucleus deep-brain stimulation (DBS) and levodopa-carbidopa intestinal gel (LCIG) in advanced PD call attention to the need for systematic investigation of risk factors and psychopathological basis related to suicidal and death ideation [3][4][5][6][7].…”

Section: Letter To Editormentioning

confidence: 99%

Suicide in Parkinson’s Disease: An Open Question and a Complex and Poorly Explored Phenomenon

Cannas¹,

Meloni²

2016

J Neurol Disord

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Letter to EditorSusceptibility to suicide and suicidal ideation is a very serious issue in patients with Parkinson's disease (PD). There is much that is still unknown about the relationship between suicide, age, medical treatment and disease in the PD patient population. Depression is the most common psychiatric disturbance that affects people with PD. On multivariate analysis, severity of depression and psychosis were the only predictors of suicide or death ideation for PD patients [1,2]. Recent reports of an increased suicide risk associated with subthalamic nucleus deep-brain stimulation (DBS) and levodopa-carbidopa intestinal gel (LCIG) in advanced PD call attention to the need for systematic investigation of risk factors and psychopathological basis related to suicidal and death ideation [3][4][5][6][7]. While it is now recognized that DBS may increase the risk of suicide, probably through increased impulsiveness, 3 the data for LCIG are still emerging [5][6][7]. The possible precipitating role of the dopamine agonist withdrawal syndrome (DAWS) in PD patients under LCIG and previously treated with dopamine agonist is gaining attention in the scientific literature [8]. However, the pathophysiology of suicide is extremely complex and evidence of DAWS being directly or indirectly associated with suicidal behavior remains meagre.We report a recent case of suicide in a patient under LCIG therapy. The patient was a 75-year-old male with a 15-year history of PD. He had an advanced PD (III-IV of Hoehn/Yahr score) with mild cognitive impairment (MMSE = 26). At the psychiatric evaluation emerged only a mild dysthymia which not required specific antidepressant treatments. Two years before starting LCIG, the patient experienced an isolated episode of short-term visual hallucinations clearly related to the introduction of pramipexole. During follow-up visits, there were no signs of impulse control disorders or psychosis but substantial decrease of motor function and unpredictable levodopa induced motor fluctuations. Unified Parkinson Disease Rating Scale motor subsection part III (UPDRS III) scores during off state was 60 of 108, whereas UPDRS III while on state was 28 of 108. At that time, he was taking immediate-release levodopa/carbidopa at the dose of 100/25 mg, 5 times daily and controlled-release levodopa/benserazide at the dose of 100/25 mg, 3 times daily. Treatment with LCIG was proposed in order to obtain a lower and more stable therapeutic regimen. LCIG infusion was started in the morning after awakening and stopped before bedtime. A significant reduction of the motor fluctuations were obtained through a LCIG titration of the morning dose to 10 ml (200 mg of levodopa), of the continuous dose to 1.9 ml (38 mg) per hour per 16 hrs a day (total dose of 808 mg) and of the extra-doses to 1.5 ml (30 mg). During follow-up evaluations we observed marked improvement in the UPDRS motor subscale scores without reporting any neuropsychiatric adverse effects, such as confusion, psychosis, depression or mania. Notably, suic...

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“…25 Estimated prevalence of suicidal ideation in PD is 23%, with estimated rate of completed suicide in PD of ,1%-2%, which is not higher than the general older adult population. [28][29][30] Depression is common even in early, untreated PD, with an estimated prevalence of 14% in de novo, or medically untreated patients. 31 Although no causative relationship is theorized, initiation of antidepressant treatment in older adults is associated with increased incidence of PD within 2 years, 32 and diagnosis of a major depressive disorder is associated with a 3.2 odds ratio for PD onset within 1 year, 33 suggesting that depression often predates the onset of clinical motor symptoms.…”

Section: Prevalence and Risk Factorsmentioning

confidence: 99%

Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease

Renfroe

Turner²,

Hinson³

2016

JPRLS

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Suicide and suicidal ideation in Parkinson's disease

Cited by 71 publications

References 34 publications

Suicide Prevention in Neurology Patients

Suicide Prevention in Neurology Patients

Suicide in Parkinson’s Disease: An Open Question and a Complex and Poorly Explored Phenomenon

Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease

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Suicide and suicidal ideation in Parkinson's disease

Cited by 71 publications

References 34 publications

Suicide Prevention in Neurology Patients

Suicide Prevention in Neurology Patients

Suicide in Parkinson’s Disease: An Open Question and a Complex and Poorly Explored Phenomenon

Prevalence, impact, and management of depression and anxiety in patients with Parkinson&rsquo;s disease

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Prevalence, impact, and management of depression and anxiety in patients with Parkinson’s disease