The suicidal phenomenon trough neurological diseases: From neurobiology to some existential perspectives

Suicides and neurological disorders are two prominent causes of mortality and chronic morbidity and are connected by complex etiopathological relationships. Growing evidence in the fields of neurology and psychiatry demonstrates that neurological illness predisposes the affected individual to an increased risk of suicide, including both suicidal ideation (SI) and behaviors (SB), the latter covering the entire range from suicide attempts (SA) to completed suicides. On one side, neurobiological hypotheses describing the etiopathogenesis of SI and SB in the context of neurological diseases relate to biological impairments that either result from pathological involvements of specific targets in the central nervous system, as a direct result of the neurological disease, or from adverse effects of the neurological treatments. On the other side, neurological diseases expose patients to subjective experiences and challenges, up to near existential positions. This mainly concerns the hopelessness due to frequent psychiatric comorbidities, unpredictability of the disease (e.g., unexpected and sudden relapses, successive progression, or chronicity), absence of curative treatments, decrease in autonomy, deterioration or loss of identity and status, a sense of uselessness, social isolation, and stigma. However, hopelessness is not the only existential condition that could be involved. The emerging constructs of demoralization and Meaning of Life (MiL) as risk and resilience factors, respectively, can also be considered and debated, especially for patients without a specific psychiatric diagnosis. It is precisely because of the heterogeneity of these aspects involved in the etiopathogenesis and consequences of neurological diseases that this work proposes to place them at the confluence of neurobiology and subjective existential experiences (Graphical abstract, Costanza et al., 2020a). Neurological diseases may thus constitute a privileged paradigm for studying the complexity of the suicidal phenomenon. Moreover, taking into consideration approaches of a different nature can help health care providers both to adjust their attitude by increasing awareness of and sensitivity to the particular nature of the neurological patients’ suffering and to consider more inclusive treatments (pharmacological and non-pharmacological) to concretely remedy it. This thesis will focus on illustrating the complex interactions between suicidality and neurological disorders within the framework outlined above. A literature review will summarize the current knowledge and outline the different schools of thought that exist on the topic, before embarking on a more detailed discussion of several relevant clinical cases and their implications. This thesis will focus on illustrating the complex interactions between suicidality and neurological disorders within the framework outlined above. A literature review will summarize the current knowledge and outline the different schools of thought that exist on the topic, before embarking on a more detailed discussion of several relevant clinical cases and their implications.