Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland.
Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy.
Int J Environ Res Public Health. 2021 Jan 20;18(3):876. doi: 10.3390/ijerph18030876.
Chronic traumatic encephalopathy (CTE) results from repetitive brain injuries and is a common neurotraumatic sequela in contact sports. CTE is often accompanied by neuropsychiatric symptoms, which could escalate to suicidal ideation (SI) and suicidal behaviour (SB). Nevertheless, fairly limited emphasis about the association between suicidality and CTE exists in medical literature. Here, we report two cases of retired professional athletes in high contact sports (boxing and ice hockey) who have developed similar clinical trajectories characterized by progressive neuropsychiatric symptoms compatible with a CTE diagnosis and subsequent SB in its severe forms (medical serious suicide attempt (SA) and completed suicide). In addition to the description of outlining clinical, neuropsychological, neuroimaging, and differential diagnosis elements related to these cases, we also hypothesized some mechanisms that might augment the suicide risk in CTE. They include those related to neurobiological (neuroanatomic/neuroinflammatory) dysfunctions as well as those pertaining to psychiatry and psychosocial maladaptation to neurotraumas and retirement from professional competitive activity. Findings described here can provide clinical pictures to improve the identification of patients with CTE and also potential mechanistic insights to refine the knowledge of eventual severe SB development, which might enable its earlier prevention.
慢性创伤性脑病（CTE）是由反复的脑损伤引起的，是接触性运动中常见的神经创伤后遗症。CTE 常伴有神经精神症状，这些症状可能会恶化至自杀意念（SI）和自杀行为（SB）。然而，医学文献中对自杀与 CTE 之间的关联关注甚少。在这里，我们报告了两名从事高接触性运动（拳击和冰球）的退役职业运动员的病例，他们表现出相似的临床轨迹，具有进行性神经精神症状，符合 CTE 诊断，随后出现严重自杀行为（医疗严重自杀企图（SA）和自杀完成）。除了描述这些病例的临床、神经心理学、神经影像学和鉴别诊断相关的元素外，我们还假设了一些可能增加 CTE 自杀风险的机制。这些机制包括与神经生物学（神经解剖学/神经炎症）功能障碍相关的机制，以及与精神病学和对神经创伤及从职业竞技活动退休的适应不良相关的机制。这里描述的发现可以提供临床图像，以提高对 CTE 患者的识别，也可以提供潜在的机制见解，以完善对最终严重 SB 发展的认识，从而可能更早地进行预防。
