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Suicides in Parkinson disorder

Parkinson disorder: It is a disorder which shows tremor ,rigidity and hypokinesia in patient due to low dopamine or dysfunction of dopaminergic receptor and neuron. 

It may induce undesired depression AMD anxiety which results in attempting suicide .There is increase in cases of suicides in PD hence it is necessory to know the reason , effects and factors affecting disorder.

Ref an article paper from Bentham science publisher vol 6  Dec 2019

1. Anxiety disorders  are  present  in  2030%  of PD  patients  and include  generalized anxiety,  social phobias  and panic  attacks  .  PD  patients  may  also  experience  additional  symptoms,  including hallucinations  ,  psychosis  ,and impulse  control  disorder   which are  often dopaminergic  treatment-related.

2.The main  goal of  treatment in  the prevention of suicide  risk  would be  to  improve  insomnia,  agitation, anxiety,  dysphoria  and depression,  given  that  all  these  conditions  are  known to  increase  suicidal  risk .

3.Several  brain  structures,  including the  anterior cingulate, ventral  prefrontal  cortex,  amygdala  and dorsal  lateral  prefrontal  cortex,  are  involved in  the  pathophysiological mechanisms  of  suicidal  ideation.

4.reduced  Sirtuins  mRNA  expression was  observed  in  peripheral  blood  cells  of unipolar  and bipolar depressed patients  and  a  Sirt 1 gene  variant  seems  to  be  associated  with suicidal  behaviors  in  bipolar disorder  electrodes,  by  inducing  local  changes  of brain  temperature, may inactivate  Sirt1 promoting the  appearance  of suicidal behaviors.  This  hypothesis  needs,  however,  to  be  further investigated.  
multiple  DBS  surgeries  in  the  same  patient  and medical complications  after  DBS  [deep brain stimulation]  also  appear  to  be  associated  with  increased  suicide  risk.  

6.A number of case  series  have  suggested  that  DBS may induce  mood-related  changes,  including depression and impulsivity,  that  may be  linked  to  suicidal  ideation.  Postoperative  depression has  frequently  been  associated  with suicidal ideation in PD.
 
This are major interpretations  in systematic review made by many authors .

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