Critical periods of suicide risk in Huntington's disease
Critical periods of suicide risk in Huntington's disease
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DOI：
10.1176/appi.ajp.162.4.725
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发表时间：
2005-04-01
影响因子：
17.7
通讯作者：
Stierman, L
中科院分区：
文献类型：
--
作者：
Paulsen, JS;Hoth, KF;Stierman, L
与普遍认为的相反，被诊断出患有毁灭性的致命疾病并不会加剧、甚至可能会减轻自杀的风险。亨廷顿研究小组数据库中的4171名个体对自杀意念进行了研究。参与者根据标准化的神经学检查进行分组，范围从0(即正常检查)到3(确诊为亨廷顿病)。明确诊断为亨廷顿病的患者进一步按疾病分期进行划分，从第1期(早期)到第5期(末期)。研究结果显示，自杀意念的频率翻了一番，从神经学检查正常的高危人群的9.1%增加到有软性神经体征的高危人群的19.8%，而患有“可能的亨廷顿氏病”的高危人群的自杀意念增加到23.5%。在诊断为亨廷顿病的患者中，16.7%的人在第一阶段有自杀意念，21.6%的人在第二阶段有自杀意念，而亨廷顿病患者有自杀意念的比例此后减少。研究结果表明，亨廷顿病自杀风险增加的两个关键时期。第一个关键期是在收到亨廷顿氏病的正式诊断之前，第二个关键期是疾病的第二阶段，此时独立性减弱。尽管亨廷顿病中自杀意念的潜在机制尚不清楚，但卫生保健提供者意识到患者可能面临更高风险的时期是至关重要的。
Contrary to popular belief, receiving a diagnosis of a devastating fatal disease does not exacerbate, and may even alleviate, the risk of suicide. Suicidal ideation was examined in 4,171 individuals in the Huntington Study Group database. Participants were grouped according to a standardized neurological examination from 0 (i.e., normal examination) to 3 ( definite Huntington's disease). Patients with an unequivocal diagnosis of Huntington's disease were further divided by stage of disease, from stage 1 ( early) to stage 5 ( end stage). Findings showed that the frequency of suicidal ideation doubled from 9.1% in at-risk persons with a normal neurological examination to 19.8% in at-risk persons with soft neurological signs and increased to 23.5% in persons with "possible Huntington's disease." In persons with a diagnosis of Huntington's disease, 16.7% had suicidal ideation in stage 1, and 21.6% had suicidal ideation in stage 2, whereas the proportion of Huntington's disease patients with suicidal ideation diminished thereafter. Findings suggest two critical periods for increased risk of suicide in Huntington's disease. The first critical period is immediately before receiving a formal diagnosis of Huntington's disease, and the second is in stage 2 of the disease, when independence diminishes. Although the underlying mechanisms of suicidal ideation in Huntington's disease are poorly understood, it is critical for health care providers to be aware of periods during which patients may be at an increased risk.