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Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

Author

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  • Alessandra Costanza

    (Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
    Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy)

  • Michalina Radomska

    (Faculty of Psychology, University of Geneva (UNIGE), 1206 Geneva, Switzerland)

  • Francesco Zenga

    (Department of Neurosurgery, City of Health and Science Hospital, 10126 Torino, Italy)

  • Andrea Amerio

    (Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
    IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
    Department of Psychiatry, Tufts University, Boston, MA 02111, USA)

  • Andrea Aguglia

    (Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
    IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy)

  • Gianluca Serafini

    (Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
    IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy)

  • Mario Amore

    (Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
    IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy)

  • Isabella Berardelli

    (Suicide Prevention Center, Department of Neurosciences, Mental Health and Sensory Organs, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy)

  • Yasutaka Ojio

    (National Center of Neurology and Psychiatry, Department of Community Mental Health Law, National Institute of Mental Health, Tokyo 187-8553, Japan)

  • Khoa D. Nguyen

    (Department of Microbiology and Immunology, Stanford University, Palo Alto, CA 94304, USA
    Tranquis Therapeutics, Palo Alto, CA 94304, USA
    Hong Kong University of Science and Technology, Hong Kong, China)

Abstract

Chronic traumatic encephalopathy (CTE) results from repetitive brain injuries and is a common neurotraumatic sequela in contact sports. CTE is often accompanied by neuropsychiatric symptoms, which could escalate to suicidal ideation (SI) and suicidal behaviour (SB). Nevertheless, fairly limited emphasis about the association between suicidality and CTE exists in medical literature. Here, we report two cases of retired professional athletes in high contact sports (boxing and ice hockey) who have developed similar clinical trajectories characterized by progressive neuropsychiatric symptoms compatible with a CTE diagnosis and subsequent SB in its severe forms (medical serious suicide attempt (SA) and completed suicide). In addition to the description of outlining clinical, neuropsychological, neuroimaging, and differential diagnosis elements related to these cases, we also hypothesized some mechanisms that might augment the suicide risk in CTE. They include those related to neurobiological (neuroanatomic/neuroinflammatory) dysfunctions as well as those pertaining to psychiatry and psychosocial maladaptation to neurotraumas and retirement from professional competitive activity. Findings described here can provide clinical pictures to improve the identification of patients with CTE and also potential mechanistic insights to refine the knowledge of eventual severe SB development, which might enable its earlier prevention.

Suggested Citation

  • Alessandra Costanza & Michalina Radomska & Francesco Zenga & Andrea Amerio & Andrea Aguglia & Gianluca Serafini & Mario Amore & Isabella Berardelli & Yasutaka Ojio & Khoa D. Nguyen, 2021. "Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms," IJERPH, MDPI, vol. 18(3), pages 1-15, January.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:3:p:876-:d:483982
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    References listed on IDEAS

    as
    1. Gianluca Serafini & Valentina Maria Parisi & Andrea Aguglia & Andrea Amerio & Gaia Sampogna & Andrea Fiorillo & Maurizio Pompili & Mario Amore, 2020. "A Specific Inflammatory Profile Underlying Suicide Risk? Systematic Review of the Main Literature Findings," IJERPH, MDPI, vol. 17(7), pages 1-22, April.
    2. Marc Baertschi & Alessandra Costanza & Alessandra Canuto & Kerstin Weber, 2018. "The Function of Personality in Suicidal Ideation from the Perspective of the Interpersonal-Psychological Theory of Suicide," IJERPH, MDPI, vol. 15(4), pages 1-14, March.
    3. Alessandra Costanza & Marc Baertschi & Hélène Richard-Lepouriel & Kerstin Weber & Isabella Berardelli & Maurizio Pompili & Alessandra Canuto, 2020. "Demoralization and Its Relationship with Depression and Hopelessness in Suicidal Patients Attending an Emergency Department," IJERPH, MDPI, vol. 17(7), pages 1-12, March.
    4. Sanna Neselius & Helena Brisby & Annette Theodorsson & Kaj Blennow & Henrik Zetterberg & Jan Marcusson, 2012. "CSF-Biomarkers in Olympic Boxing: Diagnosis and Effects of Repetitive Head Trauma," PLOS ONE, Public Library of Science, vol. 7(4), pages 1-8, April.
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