Objective: To present the hypothesis that perseveration, not just impulsivity, is a risk factor for suicide attempts in Huntington’s disease (HD).

Background: The elevated incidence of suicide attempts in patients with HD is attributed to a variety of psychosocial and cognitive changes. Impulsivity, commonly defined as an action without foresight, is considered by many to be a cognitive risk factor for suicide attempts. Many HD patients also experience perseverative thinking, an involuntary rumination, which can sporadically manifest with upsetting thoughts.

Methods: Case series of 3 HD patients that attempted suicide, where medical records, including patient accounts of motivation for suicide attempt, were reviewed.

Results: We describe three female manifest HD patients who attempted suicide. The mean age was 40 years, and all attempted suicide by overdosing on prescription medications. All noted a persistent rumination on personal stressors leading up to the attempts. Two of the patients “got stuck” on the belief that they were becoming too much of a burden to their families. The third persisted for several days on guilt over conflict in her marriage. In response to these experiences, each planned her overdose for days in advance.

Conclusions: These three patients did not appear to act impulsively in their decisions to commit suicide. In each case, a thoughtful and deliberate plan was laid out as a result of perseveration on distressing thoughts. Further research is necessary to elucidate the relationship between perseverative behaviors and suicide risk in HD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/suicide-attempts-and-huntingtons-disease-perseveration-not-just-impulsivity/