Should suicidal thoughts be addressed in obsessive–compulsive disorder patients?

ISSN 1758-2008 10.2217/NPY.11.40 © 2011 Future Medicine Ltd Neuropsychiatry (2011) 1(4), 305–308 1Department of Psychiatry, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil †Author for correspondence: Department of Neurology, Psychology & Psychiatry, Univ Estadual Paulista (UNESP; São Paulo State University), Botucatu Medical School, Botucatu, Brazil; [email protected] Excessive or irrational fear of death is a common symptom of obsessive–compul­ sive disorder (OCD), as well as of other psychiatric conditions, such as panic dis­ order. This at least partially may explain why OCD patients were long considered to be at low risk for suicide [1,2]. In fact, until recently, ‘suicidality’ was a neglected area of research for all of the anxiety dis­ orders, most studies in this area focus­ ing on mood, psychotic, substance use or personality disorders. Investigation of the non fatal aspects of suicidal behavior (thoughts, plans and attempts) is relevant, because such aspects are highly corre­ lated with each other [3,4] and are often precursors of completed suicide [5]. The initial warning signs of elevated suicide risk in individuals with anxiety disorders have come from recent epidemio­ logical studies. Population­based studies conducted in various countries [6–9] have shown that anxiety disorders, such as generalized anxiety disorder, specific pho­ bias, social phobia, post­traumatic stress disorder, panic disorder, agoraphobia and OCD, the last having been included in only one study [6], are associated with suicidal ideation and suicide attempts, independent of the effect of comorbid depression. In fact, the presence of any anxiety disorder has been shown to amplify the risk of sui­ cide attempt in persons with mood disor­ ders [6]. In a study involving 166 college students, Norton et al. demonstrated that the combination of anxiety and depression conferred an additional interactive risk for suicidal ideation [10]. Evaluating continu­ ous variables and controlling for depressive symptoms, the authors examined the risk in relation to indicators of the severity of anxiety disorders (panic, social anxiety, generalized anxiety and obsessive–com­ pulsive symptoms) and determined it to be above and beyond that related to comorbid depression. Two population­based studies spe­ cifically addressed suicide behaviors in OCD sufferers [11,12]. Using data from the first US Epidemiological Catchment “Suicide prevention is, without a doubt, one of the most important aspects of clinical practice in psychiatry because death by suicide is always dramatic and has an enormous, long-lasting, negative effect on the whole family.” Editorial