Alejos M, Vázquez-Bourgon J, Santurtún M, Riancho J, Santurtún A
Unidad de Medicina Legal, Departamento de Fisiología y Farmacología, Universidad de Cantabria, Santander, Spain.
Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, España; Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain.
Neurologia (Engl Ed). 2023 Jan-Feb;38(1):41-46. doi: 10.1016/j.nrleng.2020.03.005. Epub 2022 Sep 24.
Neurological diseases are the leading cause of disability and the second leading cause of death worldwide. Physical and psychological pain, despair, and disconnection with the environment are observed after the diagnosis of numerous neurological processes, particularly neurodegenerative diseases.
A higher risk of suicide is observed in patients with such common neurological diseases as epilepsy, migraine, and multiple sclerosis, as well as in those with such degenerative disorders as Alzheimer disease, Huntington disease, amyotrophic lateral sclerosis, and Parkinson's disease. In most cases, suicidal ideation appears in the early stages after diagnosis, in the presence of disabling symptoms, and/or in patients with psychiatric comorbidities (often associated with these neurological diseases).
Effective suicide prevention in this population group requires assessment of the risk of suicide mainly in newly diagnosed patients, in patients showing unmistakable despair or disabling symptoms, and in patients presenting psychiatric comorbidities (especially depressive symptoms). It is essential to train specialists to detect warning signs in order that they may adopt a suitable approach and determine when psychiatric assessment is required.
神经系统疾病是全球致残的主要原因,也是第二大死因。在众多神经疾病,尤其是神经退行性疾病的诊断之后,会出现身体和心理上的疼痛、绝望以及与外界脱节的情况。
在患有癫痫、偏头痛和多发性硬化症等常见神经疾病的患者中,以及在患有阿尔茨海默病、亨廷顿病、肌萎缩侧索硬化症和帕金森病等退行性疾病的患者中,观察到自杀风险更高。在大多数情况下,自杀念头出现在诊断后的早期阶段,出现致残症状时,和/或患有精神疾病合并症(通常与这些神经疾病相关)的患者中。
在这一人群中有效预防自杀需要主要对新诊断患者、表现出明显绝望或致残症状的患者以及患有精神疾病合并症(尤其是抑郁症状)的患者进行自杀风险评估。培训专家识别警示信号至关重要,以便他们能够采取适当的方法并确定何时需要进行精神评估。