Nuebling Georg S, Butzhammer Elisabeth, Lorenzl Stefan
Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany.
Department for Palliative Medicine, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany.
Front Neurol. 2021 Mar 15;12:656599. doi: 10.3389/fneur.2021.656599. eCollection 2021.
Due to the high prevalence of suicidal ideation in Parkinson's Disease (PD) and exploratory data indicating a similar prevalence in atypical Parkinsonian disorders (APD), we sought to determine the frequency of assisted suicide (AS) as well as factors driving these decisions in PD and APD. Retrospective chart analysis (2006-2012) at a Swiss Right-to-Die organization. Patients with PD and APD who completed AS were analyzed concerning disease state, symptom burden, medication, and social factors. We identified 72 patients (PD = 34, PSP = 17, MSA = 17, CBS = 4; 7.2% of all AS cases), originating mainly from Germany (41.7%), Great Britain (29.2%), and the US (8.3%). Predominant symptoms at the time of application were immobility (PD/APD: 91%/97%), helplessness (63%/70%), pain (69%/19%), dysarthria (25%/32%), and dysphagia (19%/59%). APD patients generally showed a higher symptom burden and a higher frequency of diagnosed depression (8.8%/28.9%). While most patients with diagnosed depression received antidepressants (80%), other symptoms such as pain (59%) were treated less consistently. Of note, time from diagnosis to application differed greatly between PD (8.5 ± 6.8 years) and APD (1.5 ± 1.3 years, < 0.0001). In our analysis, Parkinsonian disorders appeared to be overrepresented as a cause of AS considering the prevalence of these diseases. The observation that assisted suicide is sought early after initial diagnosis in APD implies the need for early comprehensive psychological support of these patients and their relatives.
由于帕金森病（PD）患者自杀意念的高发生率以及探索性数据表明非典型帕金森病（APD）的发生率与之相似，我们试图确定PD和APD中协助自杀（AS）的频率以及促使这些决定的因素。在瑞士一家安乐死组织进行回顾性病历分析（2006 - 2012年）。对完成AS的PD和APD患者的疾病状态、症状负担、用药情况和社会因素进行分析。我们确定了72例患者（PD = 34例，进行性核上性麻痹（PSP） = 17例，多系统萎缩（MSA） = 17例，皮质基底节综合征（CBS） = 4例；占所有AS病例的7.2%），主要来自德国（41.7%）、英国（29.2%）和美国（8.3%）。申请时的主要症状为行动不便（PD/APD：91%/97%）、无助感（63%/70%）、疼痛（69%/19%）、构音障碍（25%/32%）和吞咽困难（19%/59%）。APD患者通常症状负担更高，被诊断为抑郁症的频率更高（8.8%/28.9%）。虽然大多数被诊断为抑郁症的患者接受了抗抑郁药治疗（80%），但其他症状如疼痛（59%）的治疗则不太一致。值得注意的是，从诊断到申请的时间在PD（8.5 ± 6.8年）和APD（1.5 ± 1.3年，P < 0.0001）之间差异很大。在我们的分析中，考虑到这些疾病的患病率，帕金森病似乎作为AS的一个原因被过度代表。APD患者在初次诊断后早期就寻求协助自杀这一观察结果意味着需要对这些患者及其亲属进行早期全面的心理支持。
