Abstract
Background: Due to the high prevalence of suicidal ideation in Parkinson's Disease (PD) and exploratory data indicating a similar prevalence in atypical Parkinsonian disorders (APD), we sought to determine the frequency of assisted suicide (AS) as well as factors driving these decisions in PD and APD.Methods: Retrospective chart analysis (2006-2012) at a Swiss Right-to-Die organization. Patients with PD and APD who completed AS were analyzed concerning disease state, symptom burden, medication, and social factors.Results: We identified 72 patients (PD = 34, PSP = 17, MSA = 17, CBS = 4; 7.2% of all AS cases), originating mainly from Germany (41.7%), Great Britain (29.2%), and the US (8.3%). Predominant symptoms at the time of application were immobility (PD/APD: 91%/97%), helplessness (63%/70%), pain (69%/19%), dysarthria (25%/32%), and dysphagia (19%/59%). APD patients generally showed a higher symptom burden and a higher frequency of diagnosed depression (8.8%/28.9%). While most patients with diagnosed depression received antidepressants (80%), other symptoms such as pain (59%) were treated less consistently. Of note, time from diagnosis to application differed greatly between PD (8.5 ± 6.8 years) and APD (1.5 ± 1.3 years, p < 0.0001).Conclusions: In our analysis, Parkinsonian disorders appeared to be overrepresented as a cause of AS considering the prevalence of these diseases. The observation that assisted suicide is sought early after initial diagnosis in APD implies the need for early comprehensive psychological support of these patients and their relatives.
Highlights
Parkinson’s disease (PD) and atypical Parkinsonian disorders (APD) such as Progressive Supranuclear Palsy (PSP), Multiple Systems Atrophy (MSA), or Corticobasal Syndrome (CBS) impose an immense burden on patients and caregivers
We identified 72 patients with a primary diagnosis of PD (n = 34), PSP (n = 17), CBS (n = 4), or MSA (n = 17) who committed assisted suicide
Concerning marital status, 51.4% of the study population were married or in a relationship. 18.1% resided in a nursing home, and the majority of patients (91.4%) was accompanied by family or friends during the assisted suicide. 59.3% (32/54) of the patients with available documentation concerning religious affiliation were members of a Christian denomination, whereas no other religious affiliations could be identified
Summary
Parkinson’s disease (PD) and atypical Parkinsonian disorders (APD) such as Progressive Supranuclear Palsy (PSP), Multiple Systems Atrophy (MSA), or Corticobasal Syndrome (CBS) impose an immense burden on patients and caregivers. While single case reports describing assisted suicide (AS) in PD and APD have been published, little is known about the frequency and circumstances of AS in parkinsonian disorders. Suicidality in general has been extensively studied in PD, especially in the context of deep brain stimulation (DBS) [2]. Due to the high prevalence of suicidal ideation in Parkinson’s Disease (PD) and exploratory data indicating a similar prevalence in atypical Parkinsonian disorders (APD), we sought to determine the frequency of assisted suicide (AS) as well as factors driving these decisions in PD and APD
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