Review article
Do patients diagnosed with a neurological disease present increased risk of suicide?
¿Existe mayor riesgo de suicidio en pacientes diagnosticados de una enfermedad neurológica?
a Unidad de Medicina Legal, Departamento de Fisiología y Farmacología, Universidad de Cantabria, Santander, Spain
b Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, España; Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
c Departamento de Enfermería, Universidad de Cantabria, Centro Hospitalario Padre Men, Santander, Spain
d Departamento de Neurología, Hospital Sierrallana, IDIVAL, CIBERNED, Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
Read
1297
Timeswas read the article
287
Total PDF
1010
Total HTML
Share statistics
array:25 [ "pii" => "S2173580822001006" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2020.03.005" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "1430" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Neurologia. 2023;38:41-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485320301298" "issn" => "02134853" "doi" => "10.1016/j.nrl.2020.03.003" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "1430" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Neurologia. 2023;38:42-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "¿Existe mayor riesgo de suicidio en pacientes diagnosticados de una enfermedad neurológica?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "48" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Do patients diagnosed with a neurological disease present increased risk of suicide?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Alejos, J. Vázquez-Bourgon, M. Santurtún, J. Riancho, A. Santurtún" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Alejos" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Vázquez-Bourgon" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Santurtún" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Riancho" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Santurtún" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580822001006" "doi" => "10.1016/j.nrleng.2020.03.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822001006?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485320301298?idApp=UINPBA00004N" "url" => "/02134853/0000003800000001/v1_202212231625/S0213485320301298/v1_202212231625/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580821001826" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2020.02.012" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "1389" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Neurologia. 2023;38:47-53" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Cannabinoids in epilepsy: clinical efficacy and pharmacological considerations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "47" "paginaFinal" => "53" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cannabinoides en epilepsia: eficacia clínica y aspectos farmacológicos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:9 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Adapted from: Perucca.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>" "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1623 "Ancho" => 2507 "Tamanyo" => 237349 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mean reduction in seizure frequency in the 3 clinical trials evaluating the efficacy of CBD as an adjuvant therapy in patients with Dravet syndrome and Lennox-Gastaut syndrome. For Dravet syndrome, seizure frequency refers to convulsive seizures. For Lennox-Gastaut syndrome, seizure frequency refers to drop attacks. <span class="elsevierStyleItalic">P</span>-values refer to comparisons between the CBD group and the placebo group in each trial. References <a class="elsevierStyleCrossRefs" href="#bib0175">35–37</a> provide further information on these results.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Espinosa-Jovel" "autores" => array:1 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Espinosa-Jovel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485320300402" "doi" => "10.1016/j.nrl.2020.02.005" "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/S0213485320300402?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001826?idApp=UINPBA00004N" "url" => "/21735808/0000003800000001/v1_202301170615/S2173580821001826/v1_202301170615/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580821001802" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2019.12.006" "estado" => "S300" "fechaPublicacion" => "2023-01-01" "aid" => "1393" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2023;38:35-40" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Nutritional status and prevalence of dysphagia in cerebral palsy: usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "35" "paginaFinal" => "40" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala <span class="elsevierStyleItalic">Eating and Drinking Ability Classification System</span> y su relación con el grado de afectación funcional según el <span class="elsevierStyleItalic">Gross Motor Function Classification System</span>" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1490 "Ancho" => 3000 "Tamanyo" => 217987 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of our sample according to the predominant motor disorder, topographical distribution of cerebral palsy, and functional status according to the Gross Motor Function Classification System (GMFCS).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. García Ron, R.M. González Toboso, M. Bote Gascón, M.T. de Santos, R. Vecino, A. Bodas Pinedo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "García Ron" ] 1 => array:2 [ "nombre" => "R.M." "apellidos" => "González Toboso" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Bote Gascón" ] 3 => array:2 [ "nombre" => "M.T." "apellidos" => "de Santos" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Vecino" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Bodas Pinedo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S021348532030044X" "doi" => "10.1016/j.nrl.2019.12.006" "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/S021348532030044X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001802?idApp=UINPBA00004N" "url" => "/21735808/0000003800000001/v1_202301170615/S2173580821001802/v1_202301170615/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Do patients diagnosed with a neurological disease present increased risk of suicide?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "41" "paginaFinal" => "46" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Alejos, J. Vázquez-Bourgon, M. Santurtún, J. Riancho, A. Santurtún" "autores" => array:5 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Alejos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Vázquez-Bourgon" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Santurtún" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Riancho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:4 [ "nombre" => "A." "apellidos" => "Santurtún" "email" => array:1 [ 0 => "ana.santurtun@unican.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unidad de Medicina Legal, Departamento de Fisiología y Farmacología, Universidad de Cantabria, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, España; Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Enfermería, Universidad de Cantabria, Centro Hospitalario Padre Men, Santander, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Departamento de Neurología, Hospital Sierrallana, IDIVAL, CIBERNED, Departamento de Medicina y Psiquiatría, Facultad de Medicina, Universidad de Cantabria, Santander, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Existe mayor riesgo de suicidio en pacientes diagnosticados de una enfermedad neurológica?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Around 804 000 people worldwide are estimated to die by suicide each year; furthermore, for each suicide, there are 20 attempts.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In Spain, suicide is the main cause of violent death<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>; since 2008, the number of deaths by suicide has exceeded the number of deaths due to traffic accidents.</p><p id="par0010" class="elsevierStylePara elsevierViewall">People who commit suicide frequently have mental health disorders: history of psychiatric disorders is found in up to 90% of cases.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Depressive syndrome has been identified as one of the main predictors of suicide.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical pain has also been found to be a risk factor for suicidal thoughts, although this factor has been studied less extensively. Furthermore, depression is a frequent comorbidity in numerous diseases, and the risk of suicide increases with the number of comorbid diagnoses.</p><p id="par0020" class="elsevierStylePara elsevierViewall">According to Klonsky et al.,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> depression, impulsivity, and hopelessness are the 3 main components of suicide. The authors propose the 3-step theory of suicide, according to which the combination of 3 factors explains the progression from suicidal ideation to behaviour (whether attempt or suicide). The first step involves feelings of pain and hopelessness, which in turn promote suicidal ideation. In the second step, these individuals lose connectedness with their setting as they lack a meaningful life project and lose their personal relationships. The third step is suicide capacity, with impulsivity being the key factor in the progression from ideation to behaviour.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Several neurological diseases cause physical and psychological pain, feelings of hopelessness, and disconnectedness. Recently, several authors have analysed the relationship between these diseases and suicidal behaviour. Our working hypothesis was that the prevalence of suicide is higher among patients with neurological diseases, especially neurodegenerative diseases, than in the general population. We conducted a systematic review of studies into the topic.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Suicide and neurological diseases</span><p id="par0030" class="elsevierStylePara elsevierViewall">Neurological diseases represent the main cause of disability-adjusted life years lost worldwide and the second leading cause of death, after cardiovascular diseases, causing 16.8% of deaths.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the last 25 years, the number of deaths due to neurological disease has increased by 36.7%, and the number of disability-adjusted life years lost has increased by 7.4%. The 2 most prevalent neurological diseases are tension-type headache and migraine. Alzheimer disease (AD) is the most frequent neurodegenerative disease, as well as the most frequent cause of dementia, affecting over 46 million people worldwide.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Increases in life expectancy due to scientific and technical advances and improvements in healthcare, nutrition, and control of infectious diseases may partially explain the upward trend in the prevalence of neurodegenerative diseases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Neurological diseases, particularly age-related diseases, have been associated with an increase in suicidal ideation and behaviour. This association is particularly strong in the case of epilepsy, multiple sclerosis, AD and other dementias, Parkinson’s disease (PD), Huntington disease (HD), and amyotrophic lateral sclerosis (ALS).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In Denmark, Eliasen et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> compared the prevalence of suicide attempts between patients diagnosed with neurological disease and healthy controls between 2006 and 2013. Interestingly, the researchers observed an increase in suicidal tendencies in patients with neurological disease (11%, vs 3% in controls), finding that the risk of attempting suicide was highest at 3 months after diagnosis, decreasing thereafter. Other independent risk factors of suicidal behaviour in patients with neurological diseases include early disease onset, cognitive impairment, moderate physical disability, and recent changes in the symptoms associated with the disease.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Epilepsy</span><p id="par0055" class="elsevierStylePara elsevierViewall">There is growing interest in the association between epilepsy and suicide, as these patients have been found to present 5 times higher risk of suicidal behaviour than the general population.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Epilepsy is one of the most frequent neurological diseases, estimated by the World Health Organization to affect 50-69 million people worldwide. Although it is more common among young individuals, its incidence and prevalence have increased in line with the increase in life expectancy, due to the higher incidence of cerebrovascular disease and degenerative dementia, 2 conditions with epileptogenic potential.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Interestingly, epilepsy and suicidal behaviour share several clinical characteristics: both are episodic phenomena presenting similar recurrence rates in the first 5 years (37% for suicide and 32% for epilepsy) and higher recurrence rates in the first 2 years.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The risk of suicide is not homogeneous among patients with epilepsy. Some studies conclude that the risk is greater among patients with temporal lobe epilepsy, women, and patients with early-onset forms. Hesdorffer et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> found a particularly strong association between cryptogenic epilepsy and suicide: in their sample, over 80% of suicide attempts were observed in patients with cryptogenic epilepsy.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The relationship between suicide and epilepsy is bidirectional. On the one hand, the risk of suicidal behaviour is higher in patients with epilepsy; on the other, brain damage secondary to a suicide attempt increases the likelihood of epilepsy.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The explanation for this association is not straightforward. Patients with epilepsy have greater predisposition to psychiatric disorders; therefore, the association with suicidal behaviour may be indirect, given the higher risk of suicidal behaviour in patients with psychiatric disorders. Furthermore, from a neurobiological viewpoint, both suicide and epilepsy are associated with neurotransmitter alterations, especially serotonergic alterations. This points to the need to screen for depressive symptoms and suicidal ideation in patients with epilepsy.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Epilepsy has been identified as a risk factor for suicide, regardless of the presence of psychiatric comorbidities. According to some researchers, this relationship may be explained by the association between suicide and treatment with certain commonly prescribed antiepileptic drugs; however, recent studies have ruled out this association,<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10,12</span></a> and no alternative explanation is currently available.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Migraine</span><p id="par0085" class="elsevierStylePara elsevierViewall">Migraine is one of the most frequent causes of neurological disability, after dementia and cerebrovascular disease. It is characterised by recurrent episodes of moderate-to-severe headache that may be accompanied by visual alterations, phonophobia, or vomiting. Migraine affects 11%-23% of the global population, and frequently starts during puberty. Some patients with migraine present such neurological and psychiatric comorbidities as depression, epilepsy, cerebrovascular disease, and suicidal behaviour.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The association between migraine and suicidal behaviour has been less widely studied. Friedman et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> conducted a meta-analysis of 6 studies including a total of 148 977 patients, finding a positive association between migraine and self-harm, suicide attempts, and suicide mortality. Suicidal ideation in these patients is also associated with higher headache frequency and intensity. In addition to migraine, other less frequent but far more disabling headache disorders, such as cluster headache (also known as Horton disease) and trigeminal neuralgia, have also been associated with increased risk of suicide.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The neurobiological alterations associated with suicidal behaviour are also found in patients with migraine. Polymorphisms in the serotonin transporter gene and hypothalamic-pituitary-adrenal axis dysregulation have been associated with a higher frequency of migraine attacks.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Although the copresence of migraine and depression may explain the association between migraine and suicidal behaviour, a significant association between migraine with aura and suicidal behaviour has also been described, independently of psychiatric comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> The underlying mechanisms are poorly understood, and further research into the topic is needed.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Multiple sclerosis</span><p id="par0105" class="elsevierStylePara elsevierViewall">The risk of suicidal ideation, suicide attempt, and suicide in patients with multiple sclerosis (MS) is 1.72 times higher than in the general population. Furthermore, the risk of suicide is higher at the time of diagnosis than at symptom onset (suicide rate ratio of 2.12 vs 1.69).<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> MS is a chronic demyelinating disease of the central nervous system, mainly affecting the periventricular region, optic nerves, and spinal cord. The natural course of the disease is characterised by relapses and periods of remission, with the disease becoming increasingly disabling over time. MS affects 2.5 million people worldwide, with higher prevalence in Europe and North America.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In addition to the typical neurological symptoms (sensory alterations, partial or total vision loss, motor alterations, gait alterations, etc), patients frequently present such psychiatric disorders as depression, anxiety, and psychosis. As is the case with neurodegenerative diseases, suicidal behaviour in patients with MS is most common near the time of diagnosis, particularly in the first year after diagnosis; however, the risk of suicide in patients with MS continues to be higher than in the general population during the first 5 years of disease progression. In a placebo-controlled trial of interferon β-1b, the detection of one completed suicide and several suicide attempts in both treatment arms, with none in the placebo group, led to suggestions of a possible association between the drug and suicidal behaviour; however, this hypothesis was subsequently ruled out.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Neurodegenerative diseases</span><p id="par0115" class="elsevierStylePara elsevierViewall">Neurodegenerative diseases are characterised by progressive cerebral dysfunction and have a significant impact on the lives of these patients. Neurodegenerative diseases are frequently associated with depressive symptoms, which may promote suicidal behaviour.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Patients with poor quality of life present 4 times higher risk of suicide than those with higher quality of life.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Neurodegenerative processes affect the physical, psychological, and social spheres, and the subjective impact of the disease plays a key role. Impairment of these functions has a negative impact on daily life, potentially affecting self-perception and communication skills and leading to social stigma. Patients diagnosed with a neurodegenerative disease usually present poorer quality of life than the general population; subjective assessment of quality of life is greatly influenced by limitations in professional activity.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Patients with AD and PD, among other conditions, frequently present depressive symptoms of varying intensity at some point over the course of the disease. In some patients, these symptoms may present at early stages or even as the initial manifestation of the disease, although they have also been described at advanced stages. Depression promotes the progression of cognitive impairment.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Numerous neurologists and psychiatrists propose a combination of pharmacological and non-pharmacological treatments for depressive symptoms, as well as promoting the emotional well-being of patients diagnosed with a neurodegenerative disease, as this improves the management of the disease and also helps prevent suicidal behaviour.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Parkinson’s disease</span><p id="par0135" class="elsevierStylePara elsevierViewall">The prevalence of major depression in patients with PD is 17%. This condition increases the risk of suicidal ideation, which is observed at some point after diagnosis in over 10% of patients. Death due to suicide is 5 times more frequent in patients with PD than in the general population.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21,22</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">PD is a chronic, progressive neurodegenerative disorder characterised by disabling motor (rigidity, bradykinesia, gait alterations, resting tremor) and non-motor symptoms (eg, sleep disorders, neurocognitive alterations, urinary dysfunction).<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Li et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> found that patients with PD who committed suicide are younger, have fewer comorbidities, and present better cognitive function than patients with other neurological diseases who commit suicide. Motor fluctuations constitute a major predisposing factor for suicidal behaviour, even more so than disease severity. Furthermore, according to Hinkle et al.,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> patient perception of being untreated for motor fluctuations is in itself a predisposing factor for suicide. Therefore, patient perceptions of treatment effectiveness may be regarded as a crucial factor in preventing suicide among patients with PD.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Huntington disease</span><p id="par0150" class="elsevierStylePara elsevierViewall">Suicide is a major concern in HD.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Around 6.5% of patients attempt suicide, and 21% present suicidal ideation.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> HD is a neurodegenerative disease that follows an autosomal dominant inheritance pattern. It is caused by CAG triplet repeat expansions in the huntingtin gene, located on chromosome 4. The condition manifests between the third and fourth decades of life. Such movement alterations as chorea and dyskinesia are the most common symptoms, and are usually accompanied by psychiatric and neurocognitive alterations.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Over the course of the disease, patients present 2 critical periods for suicidal behaviour: immediately after diagnosis and when they begin to lose their independence. Van Duijn et al.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> established 5 stages of HD according to functional capacity, with stage V indicating severe dysfunction. Suicidal ideation is more frequent in stage II, regardless of the presence of motor symptoms. However, the number of suicide attempts was higher in patients in stages IV and V, with significant differences between patients in premotor stages (3%) and those in motor stages (7%).</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Amyotrophic lateral sclerosis</span><p id="par0160" class="elsevierStylePara elsevierViewall">With an incidence of 1-3 cases per 100 000 person-years, ALS is the most frequent degenerative disease of the motor neuron system.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Although its aetiopathogenesis is yet to be fully understood, the condition is characterised by progressive amyotrophy, leading to death usually within several years after diagnosis.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> As no effective treatment for ALS is currently available, patients gradually lose their independence, the ability to effectively communicate, and bodily functions.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">A study conducted in Sweden with data collected between 1965 and 2004 found that the relative risk of suicide is 6 times higher in patients diagnosed with ALS than in the general population.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In a cohort study conducted in France, including 71 patients with ALS, 39% reported suicidal ideation over the 11-month study period. Furthermore, patients with suicidal ideation more frequently presented depressive symptoms and disability than patients who did not present suicidal ideation. Patients not reporting suicidal thoughts also achieved significantly better survival and coping beliefs subscore of the Reasons for Living Inventory.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">ALS requires a multidisciplinary approach from the time of diagnosis, including counselling about problems that may arise in the end of life (forgoing artificial nutrition and hydration, mechanical ventilation, sedation, etc), to ensure that patients’ wishes and autonomy are respected.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Open discussion enables patients to reflect and plan the end of their lives, providing comfort and addressing their fears.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> Early management is essential, as disease progression may render patients unable to communicate their wishes or affect their decision-making capacities due to cognitive limitations. Furthermore, in countries where physician-assisted suicide is legal, the nature and aggressive course of ALS may result in the patient being unable to self-administer the medication necessary to end their life.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Patients’ decisions regarding end-of-life care must be respected by healthcare professionals, always in compliance with the law. Clinical management of patients with advanced ALS should aim to maximise quality of life by minimising physical, psychosocial, and emotional distress. At this stage, the physician’s communication skills play a key role.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Alzheimer disease</span><p id="par0190" class="elsevierStylePara elsevierViewall">AD is the leading cause of loss of independence in older adults. From a clinical viewpoint, it is characterised by cognitive dysfunction, which usually affects episodic memory and causes behaviour disorders.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> AD is associated with moderate risk of suicide.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Several studies have reported a greater risk of suicide among older adults with a diagnosis of AD, especially at disease onset.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> It has been hypothesised that, during the early stages of the disease, patient awareness of cognitive impairment, feelings of being a burden, and anticipated loss of independence are key factors in suicidal ideation. Furthermore, shortly after diagnosis, cognitive function is sufficiently preserved to plan and commit suicide.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Given the high frequency of psychiatric disorders identified as risk factors for suicide in patients with AD, some researchers have suggested that AD is in itself an independent risk factor for suicide. The risk of suicide increases considerably in patients with AD and comorbid depression. A study including 294 952 patients with dementia concluded that most suicides were committed by patients who were receiving psychiatric treatment.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> However, we should be aware that such neuropsychiatric symptoms as depression, psychosis, and anxiety are typical of AD and are in fact linked to the pathophysiological basis of the disease.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36,37</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">The incidence of neuropsychiatric symptoms is lower at later stages of AD than in age-matched individuals without the disease; it has therefore been hypothesised that severe cognitive impairment and executive dysfunction may protect against suicidal ideation.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Assessment of suicide risk</span><p id="par0210" class="elsevierStylePara elsevierViewall">To evaluate suicide risk, we first need to study risk factors and protective factors. In addition to the physical problems mentioned above, we also describe other risk factors for suicide. Static risk factors include male sex and history of self-harm. Dynamic risk factors include toxic substance use (mainly alcohol or drugs of abuse), acute mental illness, unemployment, living alone, and being single.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39,40</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">On the other hand, family support, strong religious faith, having children at home, a sense of responsibility for others, and problem-solving skills are protective factors.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">39–41</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">Neurologists should be aware of these protective and risk factors, and bear in mind that the risk of suicide increases shortly after diagnosis of neurological disease, when patients begin to develop disabling symptoms, and in patients with psychiatric comorbidities, which are frequently associated with the neurological disease. More specifically, patients with depressive symptoms and other issues should undergo thorough risk assessment and receive both pharmacological treatment and psychological support.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Sinclair and Leach<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> mention several profiles observed during the medical interview that should lead to an assessment of suicide risk, such as severely depressed patients, patients whose behaviour can evoke feelings of boredom in the physician or a sense that they are undeserving, and those with extreme behaviours at consultations (eg, withdrawal, agitation, etc). The authors also provide a list of questions that may be useful during history-taking and indicate the situations requiring referral to the psychiatry department.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0230" class="elsevierStylePara elsevierViewall">The available evidence suggests that the risk of suicide is higher among patients with such neurological diseases as epilepsy, migraine, and MS, or degenerative diseases including AD, HD, and PD. This increased risk is usually observed in patients with a recent diagnosis, disabling symptoms, and/or psychiatric comorbidities, which are frequently associated with the neurological disease.</p><p id="par0235" class="elsevierStylePara elsevierViewall">To ensure effective prevention, healthcare professionals should evaluate the risk of suicide in this population group, especially shortly after diagnosis and in patients with symptoms or psychiatric comorbidities known to be associated with increased risk of suicide. Neurologists and primary care physicians should receive training for suicide risk assessment and management, and follow up these patients. Early identification of warning signs and referral to the appropriate specialist is crucial in suicide prevention.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1833258" "titulo" => "Abstract" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Development" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1598053" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1833259" "titulo" => "Resumen" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Desarrollo" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1598052" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Suicide and neurological diseases" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Epilepsy" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Migraine" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Multiple sclerosis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Neurodegenerative diseases" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Parkinson’s disease" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Huntington disease" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Amyotrophic lateral sclerosis" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Alzheimer disease" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Assessment of suicide risk" ] 11 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 12 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-04" "fechaAceptado" => "2020-03-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1598053" "palabras" => array:5 [ 0 => "Suicide" 1 => "Neurological diseases" 2 => "Neurodegenerative diseases" 3 => "Risk factor" 4 => "Prevention" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1598052" "palabras" => array:5 [ 0 => "Suicidio" 1 => "Enfermedades neurológicas" 2 => "Enfermedades neurodegenerativas" 3 => "Factor de riesgo" 4 => "Prevención" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Neurological diseases are the leading cause of disability and the second leading cause of death worldwide. Physical and psychological pain, despair, and disconnection with the environment are observed after the diagnosis of numerous neurological processes, particularly neurodegenerative diseases.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Development</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A higher risk of suicide is observed in patients with such common neurological diseases as epilepsy, migraine, and multiple sclerosis, as well as in those with such degenerative disorders as Alzheimer disease, Huntington disease, amyotrophic lateral sclerosis, and Parkinson’s disease. In most cases, suicidal ideation appears in the early stages after diagnosis, in the presence of disabling symptoms, and/or in patients with psychiatric comorbidities (often associated with these neurological diseases).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Effective suicide prevention in this population group requires assessment of the risk of suicide mainly in newly diagnosed patients, in patients showing unmistakable despair or disabling symptoms, and in patients presenting psychiatric comorbidities (especially depressive symptoms). It is essential to train specialists to detect warning signs in order that they may adopt a suitable approach and determine when psychiatric assessment is required.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Development" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las enfermedades neurológicas representan la principal causa de discapacidad y la segunda causa de muerte a nivel mundial. El dolor físico y psicológico, la desesperanza y la desconexión con el medio están presentes tras el diagnóstico de numerosos procesos neurológicos y especialmente de las enfermedades neurodegenerativas.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Desarrollo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Existe un mayor riesgo de suicidio en pacientes con enfermedades neurológicas comunes como la epilepsia, la migraña y la esclerosis múltiple, así como en quienes padecen trastornos degenerativos como la enfermedad de Alzheimer, la enfermedad de Huntington, la esclerosis lateral amiotrófica o la enfermedad de Parkinson. En la mayoría de los casos, la ideación suicida aparece en la etapa próxima al diagnóstico, ante sintomatología invalidante, y/o en pacientes que presentan comorbilidad psiquiátrica (a menudo asociada con dichas dolencias neurológicas).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Para una prevención efectiva del suicidio en este grupo de la población debe evaluarse el riesgo principalmente en pacientes recién diagnosticados, ante la expresión de marcada desesperanza, ante sintomatología invalidante y en pacientes que presentan comorbilidad psiquiátrica (especialmente síntomas depresivos). La formación de los especialistas para detectar signos de alerta es fundamental tanto para que puedan hacer un correcto abordaje como para que sean capaces de determinar cuándo es necesaria la valoración de un especialista en psiquiatría.</p></span>" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "abst0020" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0025" "titulo" => "Desarrollo" ] 2 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusiones" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preventing suicide: a global imperative" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Saxena" 1 => "E.G. Krug" 2 => "O. Chestnov" 3 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf;jsessionid=6B53B5C2731FD526D6CA4F97ECF58BFE?sequence=1" "fecha" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does the environment affect suicide rates in Spain? A spatiotemporal analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Santurtún" 1 => "A. Santurtún" 2 => "M.T. Zarrabeitia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rpsm.2017.05.001" "Revista" => array:5 [ "tituloSerie" => "Rev Psiquiatr Salud Ment" "fecha" => "2018" "volumen" => "11" "paginaInicial" => "192" "paginaFinal" => "198" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medicina legal y toxicológica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Calabuig" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "7th edition" "fecha" => "2018" "editorial" => "Elsevier" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide and suicidal behavior" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Turecki" 1 => "D.A. Brent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(15)00234-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2016" "volumen" => "387" "paginaInicial" => "1227" "paginaFinal" => "1239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26385066" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide, suicide attempts, and suicidal ideation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.D. Klonsky" 1 => "A.M. May" 2 => "B.Y. Saffer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1146/annurev-clinpsy-021815-093204" "Revista" => array:5 [ "tituloSerie" => "Ann Rev Clin Psychol" "fecha" => "2016" "volumen" => "12" "paginaInicial" => "307" "paginaFinal" => "330" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global, regional, and national burden of neurological disorders during 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "GBD 2015 Neurological Disorders Collaborator Group" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(17)30299-5" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol" "fecha" => "2017" "volumen" => "16" "paginaInicial" => "877" "paginaFinal" => "897" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28931491" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurological diseases and risk of suicide attempt: A case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Eliasen" 1 => "K.P. Dalhoff" 2 => "H. 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" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aging and the epidemiology of epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. Beghi" 1 => "G. Giussani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000493484" "Revista" => array:6 [ "tituloSerie" => "Neuroepidemiology" "fecha" => "2018" "volumen" => "51" "paginaInicial" => "216" "paginaFinal" => "223" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30253417" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Occurrence and recurrence of attempted suicide among people with epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.C. Hesdorffer" 1 => "L. Ishihara" 2 => "D.J. Webb" 3 => "L. Mynepalli" 4 => "N.W. Galwey" 5 => "W.A. Hauser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamapsychiatry.2015.2516" "Revista" => array:7 [ "tituloSerie" => "JAMA Psychiatry" "fecha" => "2016" "volumen" => "73" "paginaInicial" => "80" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26650853" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S001650851101506X" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicidal behavior and neurological illnesses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.S. Coughlin" 1 => "L. Sher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4172/2167-1044.S9-001" "Revista" => array:4 [ "tituloSerie" => "J Depress Anxiety" "fecha" => "2013" "numero" => "Suppl 9" "itemHostRev" => array:3 [ "pii" => "S1473309917304966" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting suicidal behavior in veterans with traumatic brain injury: The utility of the personality assessment inventory" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.E. Breshears" 1 => "L.A. Brenner" 2 => "J.E. Harwood" 3 => "P.M. Gutierrez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/00223891.2010.482011" "Revista" => array:6 [ "tituloSerie" => "J Pers Assess" "fecha" => "2010" "volumen" => "92" "paginaInicial" => "349" "paginaFinal" => "355" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20552509" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epilepsy and suicidality: What’s the relationship?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.M. Pack" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5698/1535-7511-16.4.236" "Revista" => array:6 [ "tituloSerie" => "Epilepsy Curr" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "236" "paginaFinal" => "238" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27582659" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review and meta-analysis of migraine and suicidal ideation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.E. Friedman" 1 => "B. Gelaye" 2 => "P.A. Bain" 3 => "M.A. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/AJP.0000000000000440" "Revista" => array:6 [ "tituloSerie" => "Clin J Pain" "fecha" => "2017" "volumen" => "33" "paginaInicial" => "659" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27648590" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of suicide risk with headache frequency among migraine patients with and without aura" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.-K. Lin" 1 => "C.-S. Liang" 2 => "J.-T. Lee" 3 => "M.-S. Lee" 4 => "H.-T. Chu" 5 => "C-L. Tsai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fneur.2019.00228" "Revista" => array:5 [ "tituloSerie" => "Front Neurol" "fecha" => "2019" "volumen" => "10" "paginaInicial" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30941087" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between suicide and multiple sclerosis: An updated meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Q. Shen" 1 => "H. Lu" 2 => "D. Xie" 3 => "H. Wang" 4 => "Q. Zhao" 5 => "Y. Xu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.msard.2019.06.012" "Revista" => array:7 [ "tituloSerie" => "Mult Scler Relat Disord" "fecha" => "2019" "volumen" => "34" "paginaInicial" => "83" "paginaFinal" => "90" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31233959" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508511013783" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple sclerosis and suicide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Feinstein" 1 => "B. Pavisian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/1352458517702553" "Revista" => array:5 [ "tituloSerie" => "Mult Scler J" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "923" "paginaFinal" => "927" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide risk in multiple sclerosis: A systematic review of current literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Pompili" 1 => "A. Forte" 2 => "M. Palermo" 3 => "H. Stefani" 4 => "D.A. Lamis" 5 => "G. Serafini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpsychores.2012.09.011" "Revista" => array:6 [ "tituloSerie" => "J Psychosom Res" "fecha" => "2012" "volumen" => "73" "paginaInicial" => "411" "paginaFinal" => "417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23148807" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality of life in patients with neurodegenerative diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. Batista" 1 => "A. Pereira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.21767/2171-6625.100074" "Revista" => array:3 [ "tituloSerie" => "J Neurol Neurosci" "fecha" => "2016" "volumen" => "7" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of chronic disease prevalence and quality of life with suicide-related ideation and suicide attempt among Korean adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Joshi" 1 => "H.B. Song" 2 => "S.A. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/psychiatry.IndianJPsychiatry_282_16" "Revista" => array:6 [ "tituloSerie" => "Indian J Psychiatry" "fecha" => "2017" "volumen" => "59" "paginaInicial" => "352" "paginaFinal" => "358" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29085096" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depressive symptoms in neurodegenerative diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Baquero" 1 => "N. Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12998/wjcc.v3.i8.682" "Revista" => array:6 [ "tituloSerie" => "World J Clin Cases" "fecha" => "2015" "volumen" => "3" "paginaInicial" => "682" "paginaFinal" => "693" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26301229" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased suicide risk and clinical correlates of suicide among patients with Parkinson’s disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Lee" 1 => "H.B. Lee" 2 => "M.H. Ahn" 3 => "J. Kim" 4 => "M.S. Kim" 5 => "S.J. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.parkreldis.2016.09.006" "Revista" => array:6 [ "tituloSerie" => "Parkinsonism Relat Disord" "fecha" => "2016" "volumen" => "32" "paginaInicial" => "102" "paginaFinal" => "107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27637284" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perceived treatment status of fluctuations in Parkinson disease impacts suicidality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.T. Hinkle" 1 => "K. Perepezko" 2 => "Z. Mari" 3 => "L. Marsh" 4 => "G.M. Pontone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jagp.2018.01.005" "Revista" => array:5 [ "tituloSerie" => "Am J Geriatr Psychiatry" "fecha" => "2018" "volumen" => "26" "paginaInicial" => "700" "paginaFinal" => "710" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perceived treatment status of fluctuations in Parkinson disease impacts suicidality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.T. Hinkle" 1 => "K. Perepezko" 2 => "Z. Mari" 3 => "L. Marsh" 4 => "G.M. Pontone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jagp.2018.01.005" "Revista" => array:6 [ "tituloSerie" => "The American Journal of Geriatric Psychiatry" "fecha" => "2018" "volumen" => "26" "paginaInicial" => "700" "paginaFinal" => "710" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29609901" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide in Parkinson’s disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W. Li" 1 => "M.M. Abbas" 2 => "S. Acharyya" 3 => "H.L. Ng" 4 => "K.Y. Tay" 5 => "W.L. Au" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/mdc3.12599" "Revista" => array:6 [ "tituloSerie" => "Mov Disord Clin Pract" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "177" "paginaFinal" => "182" "itemHostRev" => array:3 [ "pii" => "S0168827820305481" "estado" => "S300" "issn" => "01688278" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perseveration and suicide in Huntington’s disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O.C. Roman" 1 => "J. Stovall" 2 => "D.O. Claassen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3233/JHD-170249" "Revista" => array:6 [ "tituloSerie" => "J Huntingtons Dis" "fecha" => "2018" "volumen" => "7" "paginaInicial" => "185" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29614688" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicidal ideation and suicidal behavior according to the C-SSRS in a European cohort of Huntington’s disease gene expansion carriers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.M. van Duijn" 1 => "E.J. Vrijmoeth" 2 => "E. Giltay" 3 => "B. Landwehrmeyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jad.2017.11.074" "Revista" => array:3 [ "tituloSerie" => "J Affect Disord" "fecha" => "2017" "volumen" => "228" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amyotrophic lateral sclerosis in northern Spain 40 years later: What has changed?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Riancho" 1 => "P. Lozano-Cuesta" 2 => "A. Santurtún" 3 => "P. Sánchez-Juan" 4 => "J.M. López-Vega" 5 => "J. Berciano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000445750" "Revista" => array:6 [ "tituloSerie" => "Neurodegener Dis" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "337" "paginaFinal" => "341" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27188850" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Why do motor neurons degenerate? Actualization in the pathogenesis of amyotrophic lateral sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Riancho" 1 => "I. Gonzalo" 2 => "M. Ruiz-Soto" 3 => "J. Berciano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2015.12.001" "Revista" => array:6 [ "tituloSerie" => "Neurologia" "fecha" => "2019" "volumen" => "34" "paginaInicial" => "27" "paginaFinal" => "37" "itemHostRev" => array:3 [ "pii" => "S2468125317300754" "estado" => "S300" "issn" => "24681253" ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physicians´ attitudes toward end-of-life decisions in amyotrophic lateral sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Thurn" 1 => "G.D. Borasio" 2 => "A. Chiò" 3 => "M. Galvin" 4 => "C.J. McDermott" 5 => "G. Mora" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/21678421.2018.1536154" "Revista" => array:3 [ "tituloSerie" => "Amyotroph Lateral Scler Frontotemporal Degener" "fecha" => "2019" "volumen" => "20" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide among patients with amyotrophic lateral sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Fang" 1 => "U. Valdimarsdóttir" 2 => "C.J. Fürst" 3 => "C. Hultman" 4 => "K. Fall" 5 => "P. Sparén" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/brain/awn161" "Revista" => array:7 [ "tituloSerie" => "Brain" "fecha" => "2008" "volumen" => "131" "numero" => "Pt 10" "paginaInicial" => "2729" "paginaFinal" => "2733" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18669498" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wish to die and reasons for living among patients with amyotrophic lateral sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Verschueren" 1 => "G. Kianimehr" 2 => "C. Belingher" 3 => "E. Salort-Campana" 4 => "A. Loundou" 5 => "A.M. Grapperon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/21678421.2018.1530265" "Revista" => array:6 [ "tituloSerie" => "Amyotroph Lateral Scler Frontotemporal Degener" "fecha" => "2019" "volumen" => "20" "paginaInicial" => "68" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30430868" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "End-of-life management in patients with amyotrophic lateral sclerosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Connolly" 1 => "M. Galvin" 2 => "O. Hardiman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(14)70221-2" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "435" "paginaFinal" => "442" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25728958" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amyotrophic lateral sclerosis and a “death with dignity”" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. Andersen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0030222818788254" "Revista" => array:2 [ "tituloSerie" => "Omega (Westport)" "fecha" => "2018" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suicide risk in Alzheimer’s disease: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Serafini" 1 => "P. Calcagno" 2 => "D. Lester" 3 => "P. Girardi" 4 => "M. Amore" 5 => "M. Pompili" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2174/1567205013666160720112608" "Revista" => array:6 [ "tituloSerie" => "Curr Alzheimer Res" "fecha" => "2016" "volumen" => "13" "paginaInicial" => "1083" "paginaFinal" => "1099" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27449996" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of suicide in patients with dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.S. Seyfried" 1 => "H.C. Kales" 2 => "R.V. Ignacio" 3 => "Y. Conwell" 4 => "M. Valenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jalz.2011.01.006" "Revista" => array:7 [ "tituloSerie" => "Alzheimers Dement" "fecha" => "2011" "volumen" => "7" "paginaInicial" => "567" "paginaFinal" => "573" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22055973" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S001650851635171X" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of beta-amyloid protein on serotoninergic, noradrenergic, and cholinergic markers in neurons of the pontomesencephalic tegmentum in the rat" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Gonzalo-Ruiz" 1 => "I. González" 2 => "J.M. Sanz-Anquela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0891-0618(03)00046-2" "Revista" => array:7 [ "tituloSerie" => "J Chem Neuroanat" "fecha" => "2003" "volumen" => "26" "paginaInicial" => "153" "paginaFinal" => "169" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14615025" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1386653218300507" "estado" => "S300" "issn" => "13866532" ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ascending monoaminergic systems alterations in Alzheimer’s disease. Translating basic science into clinical care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Trillo" 1 => "D. Das" 2 => "W. Hsieh" 3 => "B. Medina" 4 => "S. Moghadam" 5 => "B. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.neubiorev.2013.05.008" "Revista" => array:6 [ "tituloSerie" => "Neurosci Biobehav Rev" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "1363" "paginaFinal" => "1379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23707776" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dementia and suicidal behavior" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "G. Cipriani" 1 => "C. Lucetti" 2 => "S. Danti" 3 => "C. Carlesi" 4 => "A. Nuti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ggi.12608" "Revista" => array:6 [ "tituloSerie" => "Geriatr Gerontol Int" "fecha" => "2016" "volumen" => "16" "paginaInicial" => "541" "paginaFinal" => "549" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26460091" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting suicide following self-harm: Systematic review of risk factors and risk scales" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.K.Y. Chan" 1 => "H. Bhatti" 2 => "N. Meader" 3 => "S. Stockton" 4 => "J. Evans" 5 => "R.C. O’Connor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1192/bjp.bp.115.170050pmid:27340111" "Revista" => array:5 [ "tituloSerie" => "Br J Psychiatry" "fecha" => "2016" "volumen" => "356" "paginaInicial" => "277" "paginaFinal" => "283" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National confidential inquiry into suicide and homicide by people with mental illness" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Appleby" 1 => "N. Kapur" 2 => "J. Shaw" 3 => "I.M. Hunt" 4 => "S. Flynn" 5 => "S. Ibrahim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "titulo" => "Annual report and 20 year review, October 2016" "fecha" => "2016" "editorial" => "University of Manchester" ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exploring thoughts of self-harm and suicide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Sinclair" 1 => "R. Leach" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.j1128" "Revista" => array:3 [ "tituloSerie" => "BMJ" "fecha" => "2017" "volumen" => "356" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003800000001/v1_202301170615/S2173580822001006/v1_202301170615/en/main.assets" "Apartado" => array:4 [ "identificador" => "9423" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Review articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000003800000001/v1_202301170615/S2173580822001006/v1_202301170615/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580822001006?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 0 | 7 |
| 2024 October | 35 | 5 | 40 |
| 2024 September | 63 | 12 | 75 |
| 2024 August | 35 | 14 | 49 |
| 2024 July | 38 | 7 | 45 |
| 2024 June | 39 | 10 | 49 |
| 2024 May | 38 | 9 | 47 |
| 2024 April | 32 | 19 | 51 |
| 2024 March | 92 | 8 | 100 |
| 2024 February | 99 | 20 | 119 |
| 2024 January | 47 | 8 | 55 |
| 2023 December | 61 | 14 | 75 |
| 2023 November | 90 | 22 | 112 |
| 2023 October | 81 | 18 | 99 |
| 2023 September | 31 | 7 | 38 |
| 2023 August | 24 | 6 | 30 |
| 2023 July | 26 | 5 | 31 |
| 2023 June | 26 | 9 | 35 |
| 2023 May | 52 | 13 | 65 |
| 2023 April | 29 | 8 | 37 |
| 2023 March | 23 | 21 | 44 |
| 2023 February | 25 | 21 | 46 |
| 2023 January | 17 | 13 | 30 |
| 2022 December | 0 | 7 | 7 |
| 2022 November | 0 | 8 | 8 |
| 2022 October | 0 | 3 | 3 |
Show all
