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Mov Disord. 2008 Jul 10. [Epub ahead of print] Links
Suicidal and death ideation in Parkinson's disease.
Nazem S, Siderowf AD, Duda JE, Brown GK, Ten Have T, Stern MB, Weintraub D.
Department of Psychiatry, University of Pennsylvania, Philadelphia, 
Pennsylvania, USA.

Parkinson's disease (PD) is a chronic, disabling illness affecting primarily 
the elderly and is associated with a high prevalence of depression. Although 
these are known risk factors for suicidal and death ideation, little is known 
about the prevalence and correlates of such ideation in PD. A convenience 
sample of 116 outpatients with idiopathic PD at two movement disorders 
centers were administered a modified Paykel Scale for suicidal and death 
ideation, as well as an extensive psychiatric, neuropsychological, and 
neurological battery. Univariate and multivariate logistic regression models 
were used to determine the correlates of suicidal or death ideation. Current 
death ideation (28%) or suicide ideation (11%) were present in 30% of the 
sample, and 4% had a lifetime suicide attempt. On univariate logistic 
regression analysis, increasing severity of depression (odds ratio = 2.92, 
95% CI 2.01-4.24, P < 0.001), impulse control disorder (ICD) behaviors 
sometime during PD (odds ratio = 6.08, 95% CI 1.90-19.49, P = 0.002), and 
psychosis (odds ratio = 2.45, 95% CI 1.05-5.69, P = 0.04) were associated 
with either ideation. On multivariate logistic regression analysis, only 
increasing severity of depressive symptoms (odds ratio = 2.76, 95% CI 
1.88-4.07, P < 0.001) predicted suicidal or death ideation. In conclusion, 
active suicidal or death ideation occurs in up to one-third of PD patients. 
Comorbid psychiatric disorders, more than PD-related disease variables, are 
associated with this ideation, highlighting the need for a comprehensive 
approach to the clinical care of PD patients. (c) 2008 Movement Disorder 
Society.

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