Risk factors for suicidality in Huntington disease: An analysis of the 2CARE clinical trial
Andrew McGarry, Michael P McDermott, Karl Kieburtz, Wai Lun Alan Fung, Elizabeth McCusker, Jing Peng, Elisabeth A de Blieck, Merit Cudkowicz, Huntington Study Group 2CARE Investigators and Coordinators, Gregory Suter, John Adams, Theresa Moore, Jane Forsyth, Alanna Sheinberg, Joann Belden, Katie Price, Marsha Hughes-Gay, Diane Erickson, Breanna Nickels, Misty M Thompson, Mandar Jog, Christopher Hyson, Linda Cole, Emilija Makaji, Sara-Lynn Masse, Kori Ladonna, Keith Malarick, Louisa Mook, Susan Maya, Alex Bender, Jessica Meyer, Puja Turakhia, Katherine Harwood, Erin Chung, Jennifer Lee, Rachel Goldstein, Lindsay Esposito, Kathryn Duderstadt, Sarah Lenarz, Judy Hamerlinck, Patricia Ede, Catherine Wielinski, David Shprecher, Charlyne Hickey, Ashley Owens, Nancy Pearson, Nicholas Scoglio, Matthew Grana, Carol Zimmerman, Carolyn Gray, Jean A Jaglin, Kimberly Janko, Lucia M Blasucci, Holly Lawrence, Barbara Estes, Brigid Hayward, Allison Johnson, Amit Gode, Giselle Huet, Beverly Romero-Kersh, William Thayer, Jennifer Hawkins, Kristine Wernette, Elizabeth Sullivan, Jamie Guyot, Julie Konkle, Christine O'Neill, Victoria Hunt, Michael Cartwright, Pamela King, Ingrid Scott, Amanda Martin, John Bautista, Nicole Mans, Terry Tempkin, Clement Loy, Jane Griffith, Shanthi Graham, Linda Stewart, Emily Hayes, Donna Galea, Beatriz Belmar, David Gunn, Kylie Richardson, Jillian McMillan, Joohi Jiminez-Shahed, Erica Surles, Christine Hunter, Sharon Halton, Alicia Palao, Ernesto Jimenez, Nathalie Padron, Monica Quesada, Wendy Levy, Anita Blenke, Kolleen Elliott, Lynn Oelke, London Butterfield, Peggy Perry-Trice, Sarah Wyne, Lisa Gauger, Joanna Stoner, Sarah Furtado, Carol Pantella, Mary Lou Klimek, Lorelei Tainsh, Elaine Sperin, Randi Jones, Barbara Sommerfeld, Sharon Evans, Mary Eglow, Katy Regan, Andrea Duker, Maureen Gartner, Erin Neefus, Marie Malikowski, Pamela Kristof, Marci Zomok, Lisa Niles, Margaret Lannon, Steven Rainone, Rhonda Agramonte, Angie Wernle, Johanna Hartlein, Ronda Clouse, Jean Ayan, Melissa Armstrong, Christian Lachner, Bradley Robottom, Michelle Cines, Kelly Dustin, Maura Deeley, Constance Nickerson, Samantha Gibson, Hubert Fernandez, Erin Hastings Monari, Stacy Merritt, Heather Ferreri, Alison McMurray, Camille Swartz, Anne Smith-Bova, Kyle Rizer, Michael S Okun, Adam Rosenblatt, Maryjane Ong, Claire Welsh, Nadine Yoritomo, Gregory Churchill, Shamine Poynor, William Gryder, Kathy Tracey, Edwin Serna, Marjorie Hyderkhan, Christine Zades, Joji Decolongon, Jordana Hutchinson, Kimberley Carter, Robert Y Moore, Timothy John Greenamyre, Larry S Ivanco, Nancy Lucarelli, Allison Daley, Jennifer Icenhour, Paige Pancake, Meredith Wessner, Nicole Vrettos, Stacy Horn, Matthew Stern, Lisa Altin, Iman Affan, Mary Lloyd, Jeana La Brie, Cory Hackmyer, Christine Beswick, Andrew March, Lisa Vogt-Feusi, Jane Harris, Sandra Albritton, Tracy Arthur, Leigh Beglinger, Jacky Walker, Jana Hanson, Nancy Hale, Jess Fiedorowicz, Clare Gibbons, Lina Qi, Maheleth Llinas, Nancy Diaz, Elizabeth Christ, Christen Kutz, Taff Eileen, Tracy Greaser, Katie Anderson, Alan Diamond, Mary Craff, Evelyn Rudko, Denyse Turpin, Melissa Diggin, Raymond C James, Cathi-Ann Thomas, Charles Porbeni, Albert Obiozo, Vahid Tohidi, Nnamdi Uhegwu, Shari Niswonger, Katrina Samson, Debbie Gonzalez, Donna Pendley, Rebecca McMurray, Andrew McGarry, Michael P McDermott, Karl Kieburtz, Wai Lun Alan Fung, Elizabeth McCusker, Jing Peng, Elisabeth A de Blieck, Merit Cudkowicz, Huntington Study Group 2CARE Investigators and Coordinators, Gregory Suter, John Adams, Theresa Moore, Jane Forsyth, Alanna Sheinberg, Joann Belden, Katie Price, Marsha Hughes-Gay, Diane Erickson, Breanna Nickels, Misty M Thompson, Mandar Jog, Christopher Hyson, Linda Cole, Emilija Makaji, Sara-Lynn Masse, Kori Ladonna, Keith Malarick, Louisa Mook, Susan Maya, Alex Bender, Jessica Meyer, Puja Turakhia, Katherine Harwood, Erin Chung, Jennifer Lee, Rachel Goldstein, Lindsay Esposito, Kathryn Duderstadt, Sarah Lenarz, Judy Hamerlinck, Patricia Ede, Catherine Wielinski, David Shprecher, Charlyne Hickey, Ashley Owens, Nancy Pearson, Nicholas Scoglio, Matthew Grana, Carol Zimmerman, Carolyn Gray, Jean A Jaglin, Kimberly Janko, Lucia M Blasucci, Holly Lawrence, Barbara Estes, Brigid Hayward, Allison Johnson, Amit Gode, Giselle Huet, Beverly Romero-Kersh, William Thayer, Jennifer Hawkins, Kristine Wernette, Elizabeth Sullivan, Jamie Guyot, Julie Konkle, Christine O'Neill, Victoria Hunt, Michael Cartwright, Pamela King, Ingrid Scott, Amanda Martin, John Bautista, Nicole Mans, Terry Tempkin, Clement Loy, Jane Griffith, Shanthi Graham, Linda Stewart, Emily Hayes, Donna Galea, Beatriz Belmar, David Gunn, Kylie Richardson, Jillian McMillan, Joohi Jiminez-Shahed, Erica Surles, Christine Hunter, Sharon Halton, Alicia Palao, Ernesto Jimenez, Nathalie Padron, Monica Quesada, Wendy Levy, Anita Blenke, Kolleen Elliott, Lynn Oelke, London Butterfield, Peggy Perry-Trice, Sarah Wyne, Lisa Gauger, Joanna Stoner, Sarah Furtado, Carol Pantella, Mary Lou Klimek, Lorelei Tainsh, Elaine Sperin, Randi Jones, Barbara Sommerfeld, Sharon Evans, Mary Eglow, Katy Regan, Andrea Duker, Maureen Gartner, Erin Neefus, Marie Malikowski, Pamela Kristof, Marci Zomok, Lisa Niles, Margaret Lannon, Steven Rainone, Rhonda Agramonte, Angie Wernle, Johanna Hartlein, Ronda Clouse, Jean Ayan, Melissa Armstrong, Christian Lachner, Bradley Robottom, Michelle Cines, Kelly Dustin, Maura Deeley, Constance Nickerson, Samantha Gibson, Hubert Fernandez, Erin Hastings Monari, Stacy Merritt, Heather Ferreri, Alison McMurray, Camille Swartz, Anne Smith-Bova, Kyle Rizer, Michael S Okun, Adam Rosenblatt, Maryjane Ong, Claire Welsh, Nadine Yoritomo, Gregory Churchill, Shamine Poynor, William Gryder, Kathy Tracey, Edwin Serna, Marjorie Hyderkhan, Christine Zades, Joji Decolongon, Jordana Hutchinson, Kimberley Carter, Robert Y Moore, Timothy John Greenamyre, Larry S Ivanco, Nancy Lucarelli, Allison Daley, Jennifer Icenhour, Paige Pancake, Meredith Wessner, Nicole Vrettos, Stacy Horn, Matthew Stern, Lisa Altin, Iman Affan, Mary Lloyd, Jeana La Brie, Cory Hackmyer, Christine Beswick, Andrew March, Lisa Vogt-Feusi, Jane Harris, Sandra Albritton, Tracy Arthur, Leigh Beglinger, Jacky Walker, Jana Hanson, Nancy Hale, Jess Fiedorowicz, Clare Gibbons, Lina Qi, Maheleth Llinas, Nancy Diaz, Elizabeth Christ, Christen Kutz, Taff Eileen, Tracy Greaser, Katie Anderson, Alan Diamond, Mary Craff, Evelyn Rudko, Denyse Turpin, Melissa Diggin, Raymond C James, Cathi-Ann Thomas, Charles Porbeni, Albert Obiozo, Vahid Tohidi, Nnamdi Uhegwu, Shari Niswonger, Katrina Samson, Debbie Gonzalez, Donna Pendley, Rebecca McMurray
Abstract
Objective: Most suicidality literature in Huntington disease (HD) is based on natural history studies or retrospective reviews, but reports on risk factors from clinical trials are limited.
Methods: We analyzed 609 participants from 2CARE, a randomized, double-blind, placebo-controlled clinical trial with up to 5 years of follow-up, for risk factors related to suicidality. The primary outcome variable was the time from randomization until the first occurrence of either suicidal ideation or attempt. We also considered time from randomization until the first suicide attempt as a secondary outcome variable.
Results: Depression, anxiety, bipolar disorder, antidepressant or anxiolytic use, and prior suicide attempt at baseline were associated with time to ideation or attempt. Baseline employment status, marital status, CAG repeat length, tetrabenazine use, and treatment assignment (coenzyme Q10 or placebo) were not associated with suicidality. Time-dependent variables from the Unified Huntington's Disease Rating Scale Behavioral Assessment were associated with time to suicidal ideation or attempt, driven mainly by items related to depressed mood, low self-esteem/guilt, anxiety, suicidal thoughts, irritability, and compulsions. Variables associated with time to suicide attempt alone were generally similar.
Conclusion: These data suggest psychiatric comorbidities in HD are predictive of suicidal behavior while participating in clinical trials, reinforcing the importance of clinical surveillance and treatment towards lessening risk during participation and perhaps beyond. Designing a composite algorithm for early prediction of suicide attempts in HD may be of value, particularly given anticipated trials aimed at disease modification are likely to be long-term.
Clinicaltrialsgov identifier: NCT00608881.
© 2019 American Academy of Neurology.
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Source: PubMed