Pompili Maurizio, Venturini Paola, Lamis Dorian A, Giordano Gloria, Serafini Gianluca, Belvederi Murri Martino, Amore Mario, Girardi Paolo
Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, 1035-1039, Via di Grottarossa, 00189, Rome, Italy,
Drugs Aging. 2015 Jan;32(1):21-9. doi: 10.1007/s40266-014-0233-x.
Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for stroke patients at high risk of suicide. We performed a careful search to identify articles and book chapters focused on this issue, selecting only English-language articles published from 1990 to 2014 that addressed the issue of suicide after stroke and its pharmacological management. We found 12 clinical trials that explored the relationship between stroke and suicidal ideation and/or suicidal plans and 11 investigating suicide as the cause of death after stroke. We identified stroke as a significant risk factor for both suicide and suicidal ideation, especially among younger adult depressed patients in all articles, providing further support for the association between post-stroke and suicidality. Suicide risk is particularly high in the first 5 years following stroke. Depression, previous mood disorder, prior history of stroke, and cognitive impairment were found to be the most important risk factors for suicide. Selective serotonin reuptake inhibitors (SSRIs) represent the treatment of choice for stroke survivors with suicide risk, and studies in rats have suggested that carbolithium is a promising treatment in these patients. Early identification and treatment of post-stroke depression may significantly reduce suicide risk in stroke patients.
中风是一种严重的疾病，可能会导致严重的后果，包括残疾、死亡和社会成本。中风可发生于任何年龄；然而，大多数中风发生在65岁及以上的人群中。先前的研究发现，中风会增加自杀风险，尤其是在女性和年轻患者中。本综述的目的是研究自杀与中风之间的关系，以确定哪些中风患者自杀风险较高。此外，我们回顾文献，为自杀风险高的中风患者提供药物治疗策略。我们进行了仔细的检索，以确定关注此问题的文章和书籍章节，仅选择1990年至2014年发表的英文文章，这些文章涉及中风后的自杀问题及其药物治疗。我们发现12项临床试验探讨了中风与自杀意念和/或自杀计划之间的关系，11项研究将自杀作为中风后的死亡原因。我们在所有文章中都确定中风是自杀和自杀意念的重要危险因素，尤其是在年轻的成年抑郁症患者中，这进一步支持了中风后与自杀倾向之间的关联。中风后的前5年自杀风险尤其高。抑郁症、既往情绪障碍、既往中风史和认知障碍被发现是自杀的最重要危险因素。选择性5-羟色胺再摄取抑制剂（SSRIs）是有自杀风险的中风幸存者的首选治疗药物，对大鼠的研究表明，卡马西平在这些患者中是一种有前景的治疗方法。早期识别和治疗中风后抑郁症可能会显著降低中风患者的自杀风险。
