High suicidal ideation in persons testing for Huntington's disease

Department of Psychology, Uppsala University, Uppsala, Uppsala, Sweden
Acta Neurologica Scandinavica (Impact Factor: 2.4). 10/2000; 102(3):150-61. DOI: 10.1034/j.1600-0404.2000.102003150.x
Source: PubMed


This study examined the first participants who registered for the Huntington's disease predictive testing program 1990-1995 in Stockholm, Sweden. A psychosocial investigation was performed to evaluate potential effects of the presymptomatic testing. The results showed no significant differences between 13 gene carriers and 21 noncarriers in pretest attitudes, expectations, general well-being, life satisfaction and lifestyle, the need for support, estimated sense of wellbeing or degree of health. However, both groups showed high suicidal ideation and self-injurious behavior. Noncarriers had a very high frequency of attempted suicide, and both groups had similarly pronounced psychiatric dysfunction. Their relatives also had high frequencies of psychiatric diseases, suicide or suicidal attempts. Most of the participants had a desire to meet a psychologist or a social worker. The need for counseling, using a well designed protocol, and the importance of focusing on suicide risk of participants in predictive testing programs is emphasized.

Download full-text


Available from: Tarja-Brita Robins Wahlin,
  • Source
    • "Although the first symptoms of HD often occur years after predictive genetic testing, the persons know about the definite occurrence of the disease from the moment they receive the unfavorable result. As short-term psychosocial consequences during the first year after an unfavorable test result depression, anxiety, and mental distress were reported [Meissen et al., 1988; Bloch et al., 1992; Tibben et al., 1992, 1994, 1997; Quaid and Wesson, 1995; Wiggins et al., 1996; Robins Wahlin et al., 2000]. Only a small number of patients showed severe psychological reactions (e.g., suicide, psychiatric hospitalization) after receiving the unfavorable test result [Almqvist et al., 1999]. "

    • "HD patients are afflicted with depression, dysphoria, agitation, irritability, labile mood, apathy, and anxiety [27] [28]. Also, a disproportionately high prevalence of obsessive-compulsive symptoms, sleep disturbances, personality changes, psychotic symptoms, and suicidal tendencies have been previously reported [29] [30] [31] [32]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We review recent investigations regarding the relationship between selective neurodegeneration in the human brain and the variability in symptom profiles in Huntington's disease. Huntington's disease is a genetic neurodegenerative disorder caused by an expanded CAG repeat in exon 1 of the Huntingtin gene on chromosome 4, encoding a protein called huntingtin. The huntingtin protein is expressed ubiquitously in somatic tissue, however, the major pathology affects the brain with profound degeneration in the striatum and the cerebral cortex. Despite the disease being caused by a single gene, there is a major variability in the neuropathology, as well as major heterogeneity in the symptom profiles observed in Huntington's disease patients. The symptoms may vary throughout the disease course and present as varying degrees of movement disorder, cognitive decline, and mood and behavioral changes. To determine whether there is an anatomical basis underlying symptom variation, recent studies on the post-mortem human brain have shown a relationship between the variable degeneration in the forebrain and the variable symptom profile. In this review, we will summarize the progress relating cell loss in the striatum and cerebral cortex to symptom profile in Huntington's disease.
    Journal of Huntington's disease 01/2012; 1(2):143-153. DOI:10.3233/JHD-2012-120018
    • "In the HD population, sociodemographic and clinical characteristics such as having no offspring (Baliko et al., 2004; Lipe et al., 1993), being unemployed (Almqvist et al., 1999), the presence of a depressed mood (Fiedorowicz et al., 2011; Orth et al., 2010; Wetzel et al., 2011) and a psychiatric history (Almqvist et al., 1999) were found to be of importance for suicidality and suicide. However, most studies investigating suicidality or suicide in HD were retrospective (Lipe et al., 1993), or cross-sectional (Baliko et al., 2004; Orth et al., 2010; Wetzel et al., 2011) or they focused on persons undergoing predictive testing for HD (Almqvist et al., 1999; Farrer, 1986; Robins Wahlin et al., 2000). The only prospective study investigating suicidality in HD focused on suicidal behavior in prodromal HD (Fiedorowicz et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: In Huntington's disease (HD) the risk of suicide is increased. Since suicidality may precede suicide, this study investigates prevalence, clinical associations and predictors of suicidality in HD. Suicidality was investigated in 152 mutation carriers and 56 non-carriers, and was considered present if the score on the item 'suicidal ideation' of the Problem Behaviours Assessment (PBA) was >1 point. After 2 years, 100 mutation carriers who were free of suicidality at baseline were re-assessed. Associations and predictors of suicidality were analyzed using multivariate logistic regression analysis. Eleven (20%) pre-motor and 20 (20%) motor symptomatic mutation carriers were considered suicidal compared to none of the non-carriers. Cross-sectionally, suicidal mutation carriers were more likely to use antidepressants (odds ratio=5.3), were more often apathetic (OR=2.8), more often had a depressed mood according to the PBA (OR=5.9), and were more often diagnosed with a DSM-IV depression diagnosis (OR=4.7). Independent associations were more frequent use of antidepressants (OR=4.0) and presence of a depressed mood (OR=4.2). Longitudinally, depressed mood (OR=10.6) at baseline was the only independent predictor of suicidality at follow-up. Selection bias might have occurred which could have affected the suicidality rate. It is important to screen both pre-motor and motor symptomatic HD mutation carriers for suicidality. The presence of a depressed mood is both associated with and predictive of suicidality in HD and assessment of depressed mood can help to identify individuals with increased risk for suicide.
    Journal of Affective Disorders 11/2011; 136(3):550-7. DOI:10.1016/j.jad.2011.10.031 · 3.38 Impact Factor
Show more