Citation

Vaez-Gharamaleki Y, Hosseini MS. Palliat. Support. Care 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Cambridge University Press)

DOI

10.1017/S1478951524000713

PMID

38736414

Abstract

Suicide in people with cancer is often overlooked. Suicidal ideation is 10 times more prevalent in the cancer community - moreover, nearly one-fourth of people with cancer experience different levels of depression (Hosseini Reference Hosseini2023). In the latest issue of Palliative & Supportive Care, Ishida et al. reported an interesting case of a patient with cancer who appeared to have a suicide attempt, probably as a result of thiamine deficiency-related depressive disorder (Ishida et al. Reference Ishida, Sato and Sato2024). We believe some clinical points might have been ignored in this case:

First, the patient's narration of what happened, mostly complies with a "non-suicidal self-injury" or "self-harm," rather than a suicidal attempt by definition (American Psychiatric Association 2013; Sarkhel et al. Reference Sarkhel, Vijayakumar and Vijayakumar2023), which questions the conclusion made by the authors.

Second, suppose the patient's act was a genuine and injurious attempt to end her life; we believe in this case the authors' approach the primary psychological management of the patient might have been incomplete and questionable, as several urgent measures, even hospitalization, should have been taken to prevent further self-harm (Sarkhel et al. Reference Sarkhel, Vijayakumar and Vijayakumar2023), considering that the single thiamine-based intervention was also conducted blindly.

Third, the reported thiamine deficiency in this patient might not be reliable. Thiamine typically binds to proteins in the bloodstream, mainly albumin, and hypoalbuminemia, as seen in the presented case, might contribute to bloodstream thiamine being underreported. This could significantly affect the laboratory results, since most laboratory techniques of thiamine detection are also based on detecting thiamine‐carrier proteins...

Language: en