Sunday, November 9, 2008


Posted: Sat Nov 08, 2008 4:07 am Post subject: Suicide

Dear Dr Okun / Fernandez / Rodrigue We have heard of reports on higher risk of suicide among Parkinson's patients who have undergone DBS. But excluding the post-DBS patients, the suicide rate among Parkinson's patients is lower than that of the general population. Recently, one of my Parkinson's patients committed suicide by hanging himself. He had been having auditory hallucination for some time. There was also an element of depression. In my clinical practice, I seldom encounter cases of suicide among Parkinson's patients. In view of their physical and mental sufferings, I wonder why the suicide rate in Parkinson's patients is not higher than the general population. I'd appreciate if you can give your opinion. Thanks. Dr Chew Nee Kong, Kuala Lumpur.
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Sat Nov 08, 2008 11:20 am Post subject:

It is unknown why the suicide rate is lower in PD than the general population but it may relate to the type of degeneration in the frontal lobes leading apathy and other findings. I would direct you to Valerie Voon's work in Brain that throughly reviews and addresses this important and potentially preventable risk following DBS. Brain. 2008 Oct;131(Pt 10):2720-8. Links A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson's disease. Voon V, Krack P, Lang AE, Lozano AM, Dujardin K, Sch├╝pbach M, D'Ambrosia J, Thobois S, Tamma F, Herzog J, Speelman JD, Samanta J, Kubu C, Rossignol H, Poon YY, Saint-Cyr JA, Ardouin C, Moro E. National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1428, USA. Subthalamic nucleus deep brain stimulation improves motor symptoms and quality of life in advanced Parkinson's disease. As after other life-altering surgeries, suicides have been reported following deep brain stimulation for movement disorders. We sought to determine the suicide rate following subthalamic nucleus deep brain stimulation for Parkinson's disease by conducting an international multicentre retrospective survey of movement disorder and surgical centres. We further sought to determine factors associated with suicide attempts through a nested case-control study. In the survey of suicide rate, 55/75 centres participated. The completed suicide percentage was 0.45% (24/5311) and attempted suicide percentage was 0.90% (48/5311). Observed suicide rates in the first postoperative year (263/100,000/year) (0.26%) were higher than the lowest and the highest expected age-, gender- and country-adjusted World Health Organization suicide rates (Standardized Mortality Ratio for suicide: SMR 12.63-15.64; P < 0.001) and remained elevated at the fourth postoperative year (38/100,000/year) (0.04%) (SMR 1.81-2.31; P < 0.05). The excess number of deaths was 13 for the first postoperative year and one for the fourth postoperative year. In the case-control study of associated factors, 10 centres participated. Twenty-seven attempted suicides and nine completed suicides were compared with 70 controls. Postoperative depression (P < 0.001), being single (P = 0.007) and a previous history of impulse control disorders or compulsive medication use (P = 0.005) were independent associated factors accounting for 51% of the variance for attempted suicide risk. Attempted suicides were also associated (P < 0.05) with being younger, younger Parkinson's disease onset and a previous suicide attempt. Completed suicides were associated with postoperative depression (P < 0.001). Postoperative depression remained a significant factor associated with attempted and completed suicides after correction for multiple comparisons using the stringent Bonferroni correction. Mortality in the first year following subthalamic nucleus deep brain stimulation has been reported at 0.4%. Suicide is thus one of the most important potentially preventable risks for mortality following subthalamic nucleus deep brain stimulation for Parkinson's disease. Postoperative depression should be carefully assessed and treated. A multidisciplinary assessment and follow-up is recommended._________________Michael S. Okun, M.D.

Posted: Sun Nov 09, 2008 8:59 am Post subject:

Dear Dr Okun Thanks for your opinion. Yes, I have read Valerie Voon's paper in Brain. It is an interesting study. I have to admit that all these years I myself did not really pay attention to the issue to suicide in Parkinson's. Well, Parkinson's is a very complicated subject - there is always something new to learn everyday. Dr Chew Nee Kong, Kuala
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Dr. OkunJoined: 19 Jan 2007Posts: 251Location: University of Florida
Posted: Mon Nov 10, 2008 7:56 am Post subject:

I agree with that! Keep writing and thanks for contributing so positively to the forum._________________Michael S. Okun, M.D.
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