Topic 4: Suicidality In Patients With TBI Flashcards
What is the definition of a suicide attempt?
Any non-fatal self-inflicted injurious behavior performed with intent to die as a result of that behavior
What is the definition of a suicidal intent?
Clinical determination via past or present evidence, either implicit or explicit, that a person wishes to die, intends to kill himself or herself, and understands the probable consequences of his/her actions or potential actions
What is the definition of suicidal ideations?
Thoughts of engaging in suicidal behavior where the individual has thoughts of suicide
- without suicidal intent
- with an undetermined degree of suicidal intent
- with some suicidal intent
What is known about potential neurobiological mechanisms of suicide in non brain damaged suicidal individuals?
Research on non-brain damaged samples of suicidal individuals suggests serotonergic hypofunction particularly in basal orbifrontal region of the PFC as a significant marker of suicide risk.
What are behavioral consequences of hyposerotonergic function?
Reduction in inhibitory control, leading to increased aggression/impulsivity with elevation of risk for high lethality suicidal behavior
What happens to the frontal poles as a result of TBI?
Vulnerability to injury of serotonergic and noradrenergic projections from the brain stem to the frontal cortex.
How are serotonine levels influenced by TBI?
Increase of extra cellular serotonin levels immediately after TBI. Presence of increased concentrations of serotonin and noradrenaline in the synapses may lead to down-regulation of receptors and the onset of depressive symptoms
What is the prevalence of depression in TBI patients.
Diagnosis of major depression in 11 to 33% of patients with TBI. Depression appears to be related to the severity of TBI.
Increased rate of depression in TBI could be due to the effects of TBI on …
- brain functioning
- psychological impact on the accident
- psychosocial problems
What is the definition of suicide?
Any death caused by self-inflicted injurious behavior performed with any intent to die as a result of behavior
What suggests the observation that depression is significantly more frequent in TBI than in without brain injury but with similar baseline characteristics who underwent similar levels of stress
It suggests that neuro pathological processes associated with TBI act as predisposition in the development of depression
How might neurological basis explain depression subsequent to TBI ?
Deactivation of lateral and dorsal prefrontal cortices and increased activation of ventral limbic and paralimbic structures, including the amygdala.
Also, abnormalities in the serotonergic system.
In TBI patients, impulsivity and aggression may be due to …
Pre-injury traits or symptoms resulting from frontal lobe damage resulting in inhibition
There is a higher risk of suicide in patients with severe TBI than in patients with mild injuries, however, elevated risk of suicide also in patients with concussions. This is surprising, since patients with concussions do not suffer the same long term effects as patients recovering from more severe TBI. The assumption that can be made is …
Association not the consequence of injury per se
Association arises from pre-morbid or concomitant characteristics
After severe injury, suicidality more likely to be directly related to the injury and injury sequel are, including …
- the pattern of neuropathology
- reduced adaptive abilities
- psychological reactions to the injury
- the presence of psychiatric disorders