Suicide attempt by a patient with an early phase of progressive supranuclear palsy: a case report

Suicidal ideation is reported in approximately 4% of patients with progressive supranuclear palsy (PSP); however, only three cases of PSP-related suicide attempts have been reported. Here, we report the case of a patient with early-stage PSP who attempted suicide using an organophosphorus agent. An 81-year-old man with no medical history of severe depression impulsively attempted suicide by consuming an organophosphate. After improvement of the symptoms of organophosphate poisoning, the patient exhibited mild depressive mood, insomnia, mild amnesia, attention deficit, and frontal lobe dysfunction. In addition, he exhibited neck rigidity and postural instability, but no disturbance in ocular motility. Neuroradiological examination revealed findings characteristic of PSP, such as midbrain atrophy, third ventricle enlargement, and remarkably decreased dopamine transporter availability on single-photon emission computed tomography. Based on the clinical symptoms and neuroradiological findings, he was diagnosed with early-stage PSP. In line with previous clinical reports and a forensic study regarding suicide and PSP, our case indicates that suicide may occur before the onset or in the early phases of PSP. Larger neuroradiological studies among older adults with signs of depression may be needed to clarify the involvement of PSP pathology in suicide.