Suicidal ideation in Huntington disease: The role of comorbidity

Abstract

Huntington disease (HD) is a neurodegenerative condition characterized by cognitive impairments, motor abnormalities, and psychiatric disturbance. An increased risk for suicide has been documented. The majority of HD research has focused on cognitive and motor features of HD; the implications of psychiatric manifestations have received less consideration. Recent studies have sought to identify the stages of HD in which patients are at increased risk to experience suicidal ideation, though no study has examined possible risk factors for suicidality. The current study examines the presence of psychiatric comorbidity and its involvement in suicidal ideation. Suicidal ideation was examined in 1,941 HD patients enrolled in the Huntington Study Group. Of those, 19% (N = 369) reported suicidal ideation. Logistic regression analyses indicated that depression/anxiety and aggression/irritability are significant predictors of suicidal ideation (p < 0.01). In a subsample with the greatest suicidal ideation, alcohol and drug abuse were also predictive. Findings suggest that suicide in HD may be more distinct as compared to suicide in the general population. It is recommended that all individuals with HD (specifically those with features of depression, aggression, substance abuse) have routine suicide assessment; further research is needed to understand the high rate of suicide in HD.

Immune and Neuroendocrine Mechanisms of Stress Vulnerability and Resilience

“…Healthy General population 10.3% (Kessler et al, 1994) Autoimmune diseases Multiple sclerosis 23.7-50% (Marrie et al, 2015;Siegert and Abernethy, 2005) Systemic lupus 10.8-44% (Ainiala et al, 2001;Nery et al, 2007) Rheumatoid Arthritis 13-48% (Dickens et al, 2002;Matcham et al, 2014) Neurodegenerative disorders Alzheimer's disease 30-50% (Lee and Lyketsos, 2003;Zhao et al, 2016) Parkinson's disease 7-76% (Veazey et al, 2005;Bomasang-Layno et al, 2015 ) Huntington's disease 48.2% (Wetzel et al, 2011) Metabolic disorders Obesity 20-55% (Luppino et al, 2010;Stunkard et al, 2003) Cardiovascular diseases 17-27% (Rudisch and Nemeroff, 2003;Seligman and Nemeroff, 2015) Type 2 diabetes 12.8-26% (Ali et al, 2006;Anderson et al, 2001) Infection/environmental diseases Chronic obstructive pulmonary disorders 6-42% (Maurer et al, 2008) HIV 5-42% (Cruess et al, 2003;Nanni et al, 2015) Asthma 7.6-20.2% (Jiang et al, 2014) This table was adapted from Iwata et al (2013) and updated to include recent clinical findings. (Black and Miller, 2015;Fornaro et al, 2013;Hernandez et al, 2008;Huang and Lee, 2007;Leo et al, 2006;Liu et al, 2004;Maes et al, 1993;Owen et al, 2001;Simon et al, 2008) IL-1RA ↑ ↑ or ↓ (Liu et al, 2004;Maes et al, 1997;Tsai et al, 2012) IL-2 ↑ or -- (Fornaro et al, 2013;Hernandez et al, 2008;…”

Huntington's Disease: Looking Beyond the Movement Disorder

“…In the same 1,941 patients mentioned above, approximately 25% reported a history of suicidal ideation; 19%, of current suicidal ideation; and 9.5%, of at least one suicide attempt [31] . To put these data into perspective, in the general population, suicidal ideation exists in 3.3%, and a history of a suicide attempt exists in less than 1% [36] .…”

“…To put these data into perspective, in the general population, suicidal ideation exists in 3.3%, and a history of a suicide attempt exists in less than 1% [36] . Per Wetzel et al, no demographic, motor, or cognitive variables predict suicidal behavior, but there is a significant association with depression, anxiety, and aggression, as assessed by the UHDRS [31] . When looking at those with the most severe suicidal ideation, a past or current history of alcohol abuse becomes a predictive measure as well [31] .…”

“…Per Wetzel et al, no demographic, motor, or cognitive variables predict suicidal behavior, but there is a significant association with depression, anxiety, and aggression, as assessed by the UHDRS [31] . When looking at those with the most severe suicidal ideation, a past or current history of alcohol abuse becomes a predictive measure as well [31] . Suicidal risk increases during periods of functional loss, such as when work becomes too difficult or driving is no longer possible [31] .…”

“…These symptoms are directly correlated to the severity of motor and cognitive impairments and inversely associated with overall function. In individuals (n = 1,941) with 'probable' or 'definite' manifest disease, 48.2% report treatment for past depression; 8.1%, for obsessivecompulsive disorder; and 5.2%, for psychosis [31] . Given the nature of retrospective reporting, it is impossible to know if full DSM criteria were met for the diagnoses specified.…”