Introduction
Depression is not simply limited to the mood disorder, but it is less amenable to treatment, including rehabilitation. This leads to deterioration of patients’ recovery, disagreement with caregivers, and long-term hospital days. In extreme case, suicidal attempts may occur.
We present two cases with suicidal attempt after spinal cord injury because we need to be alert and educate patients and caregivers.
Case Presentation
Case I
A 71-year-old man who underwent surgical decompression surgery due to muscle weakness caused by cervical spinal stenosis was found unconscious on a winter morning in his room where there were remnants of burned-out charcoal briquettes.
After Receiving ICU care for CO intoxication, he was transferred for rehabilitation. His initial mini mental state examination (MMSE) score 27/30, motor power was grade 4/4 in the upper extremity and grade 3~4/3~4 in the lower extremities.
During hospitalization, the patient’s memory deficiency and cognitive impairment gradually deteriorated. The last mini mental state examination (MMSE) score 4/30, motor power was weakened. After Brain MRI follow-up, the patient was diagnosed with delayed encephalopathy. The cognitive and functional improvement, which was our rehabilitation goal, was not achieved.
Case II
A 75-year-old man admitted our hospital with a back pain, left lower limb weakness (grade IV), which began in February 2018, and underwent surgical decompression under spinal stenosis diagnosis. In April 2018, he was transferred for rehabilitation because bilateral lower limb weakness persisted (grade IV/IV). In October 2018 midnight, he wasn’t confirmed in his bed, and was found hanging with electric wire in the restroom of other floor in hospital and CPR was performed, but expired.
During the hospitalization period, the patient was consistently dissatisfied with lower limb weakness after surgery and told his family that he wanted to die occasionally, and there also contained a negative mention in nursing record.
Discussion
Patients with spinal cord injuries are often accompanied by depression, and occasionally suicide attempts may occur as in these cases. Not only just because of suicidal attempt post SCI, but also because depression itself adversely affects patient’s recovery, participation in rehabilitation, and quality of life, the screening for depression in SCI patients is very important.
In our hospital, screening for depression is performed by Beck Depression Inventory (BDI) and Beck Hopelessness Scale (BHS) test for patients with SCI, and if the BHS is above 10 points, it is known to be closely related to suicidal attempt.
The depression screening tests that can be conducted in rehabilitation medicine are self-report-type depression. So there is a limit to believing in them. Therefore, we need to regularly check patients' caregivers and families to see if they have any negative thoughts or comments about life at home during their hospitalization period. |
