When Sick Brain and Hopelessness Meet: Some Aspects of Suicidality in the Neurological Patient

: Neurological diseases expose individuals to a higher risk of suicidal ideation and suicidalbehavior, including completed suicides and suicide attempts. They also represent a paradigmatic arenato study the etiopathogenic mechanisms underlying suicidality because they are emblematic of the heterogeneityand complexity of mutual interrelationships characterizing this issue. On the one hand, neurologicaldiseases imply strictly biological impairments that are postulated to be the basis of vulnerabilityto suicide or result in the need for treatments for which a suicidal risk has been hypothesized. Onthe other hand, they question some subjective experiences of neurological patients, up to near existentialpositions. Often, in fact, they are accompanied by severe hopelessness. The latter may originate in,particularly for the most severe neurological diseases, the absence of curative treatments, unpredictabledisease progression that leads to acute relapses or chronicity, a decrease in autonomy or selfidentity,progressive social isolation, a sense of becoming useless, and perception of feeling stigmatized.This may ultimately cause a slip into experiencing an absurd condition. At the confluence ofneurobiology and hopelessness, frequent psychiatric comorbidities may play a primary role. To conclude,neurological patients require special attention from clinicians in form of openly verbalizing andexploring the suicidal thematic, inquiring about protective and risk factors, and promptly initiatingboth a psychopharmacological treatment and, where possible, psychological support.