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Physicians Guide to the Management of Huntington's Disease
Suicide
Depressed patients should always be asked about suicide, and this should be regularly reassessed. It is a misconception that suicidal patients will not admit to these feelings.
 
The question should be asked in a non-intimidating, matter-of-fact way, such as "have you been feeling so bad that you sometimes think life isn't worth living?" Or, "have you even thought about suicide?"
If the patient acknowledges these feelings, the clinician needs to ask more questions to evaluate their severity and decide on the best course of action.
  • Are the feelings just a passive wish to die or has the patient actually thought out a specific suicidal plan?
  • Does the patient have the means to commit suicide?
  • Has she prepared for a suicide, such as by loading a gun or hoarding pills?
  • Can the patient identify any factors which are preventing her from killing herself?
  • What social supports are present?
Some patients, although having suicidal thoughts, may be at low risk if they have a good relationship with their doctor, have family support, and have no specific plans. Others may be so dangerous to themselves that they require emergent hospitalization.
Although there have been cases of non-depressed patients with HD harboring chronic suicidal feelings, we feel that most, if not all, suicidal patients with HD suffer from Major Depression and can be treated successfully.
 
So as not to miss such cases, it is helpful to think of all patients with HD who are suicidal as depressed until proven other-wise. If the clinician is unsure, the patient should be treated presumptively.
 
This is not to say that a person with HD, particularly early in the course of the disease may not express a fear of becoming helpless one day, or a desire not to live past a certain degree of impairment.
 
A physician should listen supportively to these concerns, realizing that most patients will be able to adapt if they are not suffering from depression.