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

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 etio-pathogenic 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 of autonomy or self-identity, progressive social isolation, a sense of becoming useless, and a perception of feeling stigmatized. This may ultimately cause a slip into the experience of an absurd condition. At the confluence of neurobiology and hopelessness, frequent psychiatric co-morbidities may play a primary role. To conclude, neurological patients require special attention from clinicians which should consist 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.

Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

“…In these two cases, possible AD diagnosis was attributed to both patients as their neuropsychiatric symptoms were well-correlated with progressive neurodegeneration in the brain. The presence of SB in these two cases was also consistent with the increased risk of suicidality in patients with AD [45][46][47][48][49]. However, unlike AD, in both cases the cognitive and psychiatric aggravation was rapid (within 2-3 years) and consistent with previously documented progression of these symptoms in CTE [50].…”

“…Collectively, these findings suggest the possible existence of a neurobiological pathway that is affected in both CTE and dementia [75,76]. Since dementia has been associated with increased suicide risk [45,46,77], it is likely that suicidality might be the ultimate consequence of this common neuropathology in CTE and dementia. Specifically, these patients may experience pronounced social stigma for this inevitable degeneration in cognitive status, eventually increasing their risk for SI and SB.…”

“…In this regard, it is plausible that both patients' neuropsychiatric and psychosocial conditions, a sort of drift in two athletes who had been famous and idolized, trigger a sense of hopelessness. Alternatively, the unpredictable nature of CTE progression might also aggravate this feeling [45,46].…”

Developing a Japanese Version of the Baron Depression Screener for Athletes among Male Professional Rugby Players

“…Previous papers have suggested that the symptom of CTE present as a form of dementia with characteristics approachable to front-temporal dementia in the later age of retired athletes [ 33 ], even in athletes of younger age, the mental health-related behavioural symptoms including depression alongside cognitive impairment and anger control problems may commence insidiously as CTE signs [ 34 ]. In addition, other research has pointed out that CTE, mood disorder, and suicidality have mutual and complex associations with each other [ 35 , 36 ]. Therefore, the possibility that some symptoms detected by the BDSA-J may suggest CTE and its related symptoms cannot be rigidly excluded.…”

Suicidality Assessment of the Elderly With Physical Illness in the Emergency Department

“…Globally, neurological diseases, pain, and oncological conditions occurred more frequently in the suicidal elderly. An association between neurologic diseases and SI, SA, and SB was observed (6,12,(51)(52)(53)(54)(55), especially for stroke and hemiplegia (4,11,13,56,57), epilepsy (4,8,45,58), and dementia (13,59,60). A greater rate of SI was documented in patients with Parkinson's disease (60,61), and the role of sub-thalamic deep brain stimulation (DBS) on suicidality risk in patients treated for extrapyramidal movement disorders is still discussed [for a recent systematic review, see (62)].…”