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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