Letter to the Editor
Spectrum of optic neuromyelitis: psychiatric disorders and suicide risk
Espectro de la neuromielitis óptica: trastornos psiquiátricos y riesgo de suicidio
Hospital General de Agudos Dr. José María Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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The gadolinium-enhanced T1-weighted sequence (1c) shows irregular peripheral “cloud-like” enhancement.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The diffusion sequence (1d and e) reveals mild restriction in the medial area, which is not suggestive of an ischaemic lesion. Series 2) Brain MRI: axial and coronal T2-weighted and FLAIR sequences showing a reduction in the size of the previous lesion (2a), and 2 new lesions: one extending towards the right basal ganglia (2b) and another predominantly left-sided lesion surrounding the third ventricle and involving the hypothalamus (2c); both lesions are gadolinium-enhancing (2d and e). Series 3) Left: spinal cord MRI. Sagittal gadolinium-enhanced T1-weighted and T2-weighted sequences (3a–c) showing multiple gadolinium-enhancing lesions, the largest extending from C4 to T2. Axial T2-weighted and gadolinium-enhanced T1-weighted sequences (3d and e) reveal heterogeneous lesions with areas of hyperintensity and hypointensity. Right: brain MRI. axial FLAIR and gadolinium-enhanced T1-weighted sequences (3f and g) show multiple new hyperintensities involving the periventricular area, corpus callosum, and left occipital lobe; most lesions present gadolinium enhancement.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N. Zhu, S. Presas-Rodríguez, F. Núñez-Marín, B. Quirant-Sánchez, C. Ramo-Tello" "autores" => array:5 [ 0 => array:2 [ "nombre" => "N." "apellidos" => "Zhu" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Presas-Rodríguez" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Núñez-Marín" ] 3 => array:2 [ "nombre" => "B." "apellidos" => "Quirant-Sánchez" ] 4 => array:2 [ "nombre" => "C." 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Morales-Casado, N. López-Ariztegui, F. Muñoz-Escudero, Á. Navarro-Bejarano, J.A. Pérez-Matos" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M.I." "apellidos" => "Morales-Casado" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "López-Ariztegui" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Muñoz-Escudero" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Navarro-Bejarano" ] 4 => array:2 [ "nombre" => "J.A." "apellidos" => "Pérez-Matos" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485320302516" "doi" => "10.1016/j.nrl.2020.07.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485320302516?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000390?idApp=UINPBA00004N" "url" => "/21735808/0000003600000005/v1_202105310504/S2173580821000390/v1_202105310504/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Spectrum of optic neuromyelitis: psychiatric disorders and suicide risk" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "395" "paginaFinal" => "396" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.M. Villa, V. Fernández" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A.M." "apellidos" => "Villa" "email" => array:1 [ 0 => "andresmaria@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Fernández" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital General de Agudos Dr. José María Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espectro de la neuromielitis óptica: trastornos psiquiátricos y riesgo de suicidio" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the detailed systematic review “Do patients diagnosed with a neurological disease present increased risk of suicide?” by Alejos et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> recently published in <span class="elsevierStyleItalic">Neurología</span>, which addresses the hypothesis that the prevalence of suicide is higher among patients with different neurological diseases, especially those of neurodegenerative origin.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors contribute evidence supporting the increased risk of suicide in patients with such neurological diseases as epilepsy, migraine, multiple sclerosis, Alzheimer disease, Huntington disease, and Parkinson’s disease. However, neuromyelitis optica spectrum disorders (NMOSD), which have been shown to be strongly associated with the risk of suicide in several communications,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> were not included among the diseases analysed. We recently conducted a prospective study that found a surprisingly high rate of suicide attempts among patients with NMOSD. Six in every 20 patients with NMOSD (30% in our cohort) had attempted suicide at least once over the course of the disease. This rate was significantly higher than in healthy controls.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We showed not only that patients with NMOSD presented more suicide attempts, but also that the risk of suicide itself was greater in this patient group. We believe that suicide should be considered a continuum, from the risk of suicide, including ideation, to planning and finally attempting suicide.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In our study, we detected current risk of suicide in 8 in every 20 patients with NMOSD. We would like to underscore the need to dedicate greater effort to identifying the risk of suicide at the time of diagnosis or of severe relapses with residual disability, since we found that most suicide attempts were made in specific situations over the course of NMOSD progression. However, we did not find a significant association between the risk of suicide and the classification of disability as measured by the Expanded Disability State Scale in our sample of patients with NMOSD.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Assessment of the risk of suicide is well developed in the Mini-International Neuropsychiatric Interview (MINI), a simple, semi-structured interview. We found that current risk of suicide, as measured with the MINI, was positively correlated with current depression, as measured with the Beck Depression Inventory (BDI), but was not always associated with major depressive disorder or another psychiatric diagnosis. Therefore, while suicidal tendencies seem not always to be related with a comorbid psychiatric condition, we believe that the BDI may be a useful tool for detecting depression and current risk of suicide in patients with NMOSD and probably other neurological conditions. The presence of psychiatric comorbidities and suicidal tendencies among patients with NMOSD has been assessed by other researchers, who have obtained similar results to our own.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> Like the authors of the study,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> we would like to highlight the need to evaluate suicidal tendencies in patients with neurological diseases, including NMOSD.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villa AM, Fernández V. Espectro de la neuromielitis óptica: trastornos psiquiátricos y riesgo de suicidio. Neurología. 2021;36:395–396.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Do patients diagnosed with a neurological disease present increased risk of suicide?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Alejos" 1 => "J. Vázquez-Bourgon" 2 => "M. Santurtún" 3 => "J. 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Horwitz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00415-018-8837-4" "Revista" => array:6 [ "tituloSerie" => "J Neurol" "fecha" => "2018" "volumen" => "265" "paginaInicial" => "1303" "paginaFinal" => "1309" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29564603" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychiatric comorbidities and suicidality among patients with neuromyelitis optica spectrum disorders in Argentina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.C. Fernández" 1 => "N. Alonso" 2 => "L. Melamud" 3 => "A.M. 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Elsone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jns.2015.11.031" "Revista" => array:6 [ "tituloSerie" => "J Neurol Sci" "fecha" => "2016" "volumen" => "360" "paginaInicial" => "4" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26723962" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003600000005/v1_202105310504/S2173580821000389/v1_202105310504/en/main.assets" "Apartado" => array:4 [ "identificador" => "9409" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003600000005/v1_202105310504/S2173580821000389/v1_202105310504/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000389?idApp=UINPBA00004N" ]
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