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SUICIDALITY IN PATIENTS WITH TOURETTE'S SYNDROME
  1. AK Gharatya,
  2. JS Stern,
  3. CHA Man,
  4. D Williams,
  5. HS Simmons,
  6. MM Robertson
  1. Department of Neurology, Atkinson Morley's Wing, St George's Hospital, Blackshaw Road, London, SW17 0QQ

Abstract

Objective To investigate the clinical characteristics of patients with suicide attempts or suicidal ideation in a cohort of Tourette (TS) patients.

Method We reviewed the clinical notes of 524 patients diagnosed with TS attending the St. George's Hospital Tic Disorder Clinic. A control group used an existing database of 141 to 469 patients, according to availability of relevant items. The following features were examined: history of suicide attempts (SA) or suicidal ideation (SI), disease severity, prevalence of co-morbidity and psychopathology, family history of suicide/suicide attempt and depression, history of substance abuse, employment status, forensic history and self-injurious behaviour (SIB).

Results Of the total cohort of 524 patients suicide attempts were recorded in 25, mean age 26.9, M:F 1.8:1 and suicidal ideation only in 30, mean age 21.4, M:F 2.3:1. SA patients recorded the highest disease severity compared to SI and control group with an average Yale Tic Severity Score of 30.4 vs. 28.3 vs. 24.6. Clinician-rated severity was “severe” in 40.9%* vs. 21.4% vs. 8.4%. SA patients also had the highest prevalence of co-morbidities and psychopathology including depression (75%* vs. 81.5%* vs. 12.3%), anxiety (80%* vs. 70.8%* vs. 12.9%), SIB (20% vs. 26.7% vs. 16.4%), ADHD (81.8%* vs. 69.00% vs. 53.92%), OCD (73.9%* vs. 51.7%* vs. 28.2%), retrospective diagnosis of oppositional defiant disorder (40%* vs. 33.3%* vs. 16.5%), retrospective diagnosis of conduct disorder (24%* vs. 6.7% vs. 4.6%.). Family history of suicide/suicide attempts were more common in SA patients (36.8%* vs. 26.7%* vs. 4.70%,) while family history of depression was greatest within the SI population (60.9%* vs. 66.7%* vs. 28.2%). (*p<0.05). Unemployment rates were also highest among SA patients compared to employment-aged members of the control group (33.3% vs. 16% vs. 15.6%). Additionally SA and SI patients had high levels of drug abuse (50% and 19.1%), alcohol abuse (43.5% and 13.6%) or a forensic history (56.5% and 13.8%) but have not been compared with an age-appropriate or matched group.

Conclusion This is the first study to examine suicidality in a clinical TS cohort. These 55 patients had severe tics, high rates of comorbidity, substance abuse, forensic history and family history of suicide attempt. Limitations include referral bias and an age-unmatched control population, hence we have not yet given a prevalence figure for suicide attempts as it is important for this to be valid.

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