When Sick Brain and Hopelessness Meet: Some Matters on Suicidality in the Neurological Patient.

Neurological diseases expose individuals to a higher risk of suicidal ideation and suicidal behavior, including completed suicides and suicide attempts. They also represent a paradigmatic arena to study the etio-pathogenic mechanisms underlying suicidality because they are emblematic of the heterogeneity and complexity of mutual interrelationships characterizing this issue. On the one hand, neurological diseases imply strictly biological impairments that are postulated to be the basis of vulnerability to suicide or result in the need for treatments for which a suicidal risk has been hypothesized. On the other hand, they question some subjective experiences of neurological patients, up to near existential positions. Often, in fact, they are accompanied by severe hopelessness. The latter may originate in, particularly for the most severe neurological diseases, the absence of curative treatments, unpredictable disease progression that leads to acute relapses or chronicity, a decrease of autonomy or self-identity, progressive social isolation, a sense of becoming useless, and a perception of feeling stigmatized. This may ultimately cause a slip into the experience of an absurd condition. At the confluence of neurobiology and hopelessness, frequent psychiatric co-morbidities may play a primary role. To conclude, neurological patients require special attention from clinicians which should consist of openly verbalizing and exploring the suicidal thematic, inquiring about protective and risk factors, and promptly initiating both a psychopharmacological treatment and, where possible, psychological support. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.