Friday, 16 November 2012

Suicide and MS

Pompili et al. Suicide risk in multiple sclerosis: A systematic review of current literature. J Psychosom Res. 2012; 73:411-417.

BACKGROUND: Studies have shown that suicidal ideation is often revealed among MSers. Mental health assessment of physically ill MSers should form part of routine clinical evaluation, particularly in chronic illness.

OBJECTIVE: The aim of the present paper was to investigate whether there was a relationship between MS and suicidal behaviour.

METHODS: A systematic review of the literature was conducted to determine the potential association between MS and suicidal behaviour  A total of 12 articles from peer-reviewed journals were considered and selected for this review.

RESULTS: Most studies have documented a higher suicide rate in MSers compared to the general population, and suicide was associated with several risk factors: Depression severity, social isolation, younger age, progressive disease subtype, lower income, earlier disease course, higher levels of physical disability, and not driving.

CONCLUSIONS: Clinicians should be aware of the fact that suicidality may occur with higher frequency in MSers, the available data suggest that the risk of self-harm is higher than expected in MS patients.


"Suicide is a an awful thing, and is commoner in MSers. I will never forget the first time a patient I was looking after committed suicide. I will never be free of the guilt; could I have prevented it? Nor will I have my questions answered: Why? Was life so bad? We need to do everything we can to avoid it. If you have a problem with mood and anxiety and have had suicidal thoughts don't ignore them let your nurse, family doctor or neurologist know. There are things that can be done to help you."

"The following is the Suicidal Intent Scale that is commonly used to assess suicide risk."

Pierce Suicidal Intent Scale

Isolation:
  0 Somebody present
  1 Somebody nearby or in contact (as by phone)
  2 No-one nearby or in contact

Timing
  0 Timed so that intervention is probable
  1 Timed so that intervention is unlikely
  2 Timed so that intervention is highly unlikely

Precautions against discovery:
  0 No precautions
  1 Passive precautions eg avoiding others but doing nothing to prevent their intervention 
       (e.g. alone in room, door unlocked)
  2 Active precautions (eg locked doors)

Acting to gain help during or after attempt
  0 Notified helper regarding attempt
  1 Contacted but did not specifically notify helper regarding the attempt
  2 Did not contact or notify potential helper

Final acts in anticipation of death:
  0 None
  1 Partial preparation or ideation
  2 Definite plans made (eg changes in will, taking out insurance)

Suicide note:
  0 No note
  1 Note written but torn up
  2 Presence of note

Self report Patient's statement of lethality
  0 Thought that what he had done would not kill him
  1 Unsure whether what he had done would kill him
  2 Believed that what he had done would kill him

Stated intent
  0 Thought that what he had done would not kill him
  1 Unsure whether what he had done would kill him
  2 Believed that what he had done would kill him

Premeditation
  0 Impulsive, no premeditation
  1 Considered act for approx 1 hour
  2 Considered act for approx 1 day
  3 Considered act for more than 1 day

Reaction to act
  0 Patient glad he had recovered
  1 Patient uncertain whether he is glad or sorry
  2 Patient sorry he has recovered

Risk Predictable outcome in terms of lethality of patient's act 
and circumstances known to him/her
  0 Survival certain
  1 Death unlikely
  2 Death likely or certain

Would death have occured without medical treatment?
  0 No
  1 Uncertain
  2 Yes

Total score:
  0-3 Low risk
  4-10 Medium risk
  11+ High risk

14 comments:

  1. Prof G,

    3 steps to reduce the risk:

    - achieve DAF
    - stop progression (neuro-protection agents)
    - encourage some repair

    This will give patients hope for the future (not having any hope is the main factor behind suicide). Woudl you want to end up like Debbie Purddy? Whn tthe future looks so bleak (job loss, loss of independced etc) endign iot can look liek a realese.

    You runs, you travel, you have a job you love. All of su want this. When weare cruelly robbed of these thigns which make life great, then sucide offers a end to the losses / suffering.

    You can't blame yourself for a patient who commits suicide. However, the curretn MS research set-up needs to lokk at itself and consider why progress has been so slow. It's always jam tomorrow with MS research. Things are on the horiszon. The quicker the three things above can be deliveed, the more lives will be svaed. Gettign an efffective neuro-protective agent would be a massive plus for those who are trackign themselves on the EDSS. Stability allows peopel to build on what they have. Soem repair, even small, would really change an MS patients outlook. We need to see a day when all this academic MS research is in the past i.e. it leads to treatments which effectively stop the disease in its tracks.

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    Replies
    1. Agreed. Progress is way too slow. It's all noise and no product.

      I went on a second date with someone that I was convinced liked me a lot. Told them I had MS and they never called me back. People are such bastards. Sometimes society gets you more down than the disease.

      Still, love to see the day when you can fix MS damage a little bit. When can we expect such good news?

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    2. When you can fix MS damage a little bit.

      Ask the Edinburgh/Cambridge, etc, Lot, that's their job :-)

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    3. New drug called alemtuzumab that caused some patients to recover abilities in clinical studies. It's approved in Europe, about to be approved in US.

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  2. I'm sorry but there's a need for some real tough love here:

    "I went on a second date with someone that I was convinced liked me a lot. Told them I had MS and they never called me back. People are such bastards. Sometimes society gets you more down than the disease."

    I can guarantee the every single human being has been on a second date with someone they were convinced liked them a lot but who never called them back. I know I have. Might it have been the MS? It's possible. Might it have been a whole host of other things? Absolutely! We're far too quick to lay all of our woes at the door of our MS sometimes.

    Equally, the other poster needs to be careful not to lump all of us into the "we". I have MS and I have a job I love, I travel...(okay, I don't run but I do cycle and swim regularly). Many of us are so far from the image of Debbie Purdy that is does us a disservice to lump us into a collective group of people without a love of life. I love my life. It is great; far better in many, many ways than many people I know without MS. Is my future uncertain - yes (but then so is that of everyone in many respects). Is it bleak? I don't think so, no. I'm not at all unsympathetic to those whose MS is so bad as to cause them to look at life in this way but that's not all of us with MS - far from it. The MSer I know are spirited, determined, dynamic individuals who are living good lives and not letting their condition stop them.

    Where I definitely agree with both of these posts is the desirability of the need for new therapies, but I'm equally sure that Prof G isn't sitting around twiddling his thumbs...!

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  3. I would think to feel guilt over this is to overstate your own ability to impact the person's life. For many people, MS is awful on a daily basis.
    I think suicide is abhorrent and terribly sad.

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  4. Easy to be spirited when you can still work, swim, and cycle. For those of us who have been robbed of these enjoyments who have been robbed of work,love,independence etc these thoughts often are a daily battle to be fought so until you are in this position and I hope you never are I think your statement "there's a need for some real tough love here" is inappropriate and insensitive.

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    Replies
    1. I have a much more detailed explanation of the despair and hopelessness caused by not being able to function in a manner in which to obtain any of the basic, fundamental things in life. The things that give us hope that we might obtain happiness and not just survive. Be that as it may, I will also be basic and simple in my explanation as it applies to my condition and state of mind. My physical abilities are limited to a few steps at a time at best...limited movement of my arms...constant numbness in my feet, legs, hands and lower abdomen. Constant feeling of dead weight in my legs and arms. All I have are my thoughts and the feelings prompted by those thoughts. Living in the past (which was so much better) is the only thing that keeps me going. The advice and suggestions from people (professional & personal) who don't have MS is well intended but unfounded. The feeling of insignificance is more overwhelming than normal. If a person is able to function physically, therefore make choices and follow thru with them (do shit), they can pretend that they are more significant than they really are............Frank T

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  5. I have told myself for the first time ever that if there is a God that I hate him. Who would ever allow a healthy person to crash and burn piece by piece while the rest of the world carries on? This is just a cruel, sick joke.

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    Replies
    1. Life is neither fair or unfair, it is how we perceive it. It is often about the qualities we hold as meaningful to us that will determine the outcome/s. Though in the midst of a depressive episode (with crappy MS), that is very hard to hold on to. If there is such a 'thing' or presence known as god then - in my perception- s/he/it sucks ;).

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  6. I am a MSer secondary progressive and unfortunately I am still here after trying to end my life a week ago.
    Something isn't working In my head. I had been productive and functional up till October 2015 with RRMS. Depression and major stress pushed me over the edge. When I took 24 Norco I made sure I had twice the leathal dose. Plus some oxy to boot.
    My family business died
    My marriage died
    My family conections were bad
    And much more.
    When we snap there's no more logic or rational thought. Just a strong desire to be free of the physical and emotional pain. and the financi

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  7. This comment has been removed by a blog administrator.

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  8. Up until July 2015 worked as a lab tech with 2 jobs 60-65 hours a week. In July 2015 work up paralyzed and the fun began. Regained some leg movement but can't walk. Then October woke up paralyzed again and all he'll broke out. Hospitalso and nursing homes at 42.Then a stroke in December 2015. Now waiting for open heart surgery because the doctor putting in my catheter for plasmapheresis put it in wrong so no need open heart surgery. Have over 30 lesions on my brain and not included the spine. And yes tried suicide. Every thing was taken from me work,friends,driving etc. So I would pick words very carefully cause at any time it could be you. I would give anything to walk,run,dance and drive. So to all who understand my feeling is hear that voice of hurt coming from you.

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  9. Dear Francesca
    I am sorry that you feel this way, but we can not post your comment but please , please talk to your health care professionals about your thoughts as there may be things that can be done.

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