Frequency of suicides in the deaths of epileptic patients.
\r\n\tThe study of populations and plant communities in their different aspects; ecological, structural, functional and dynamic, it is essential to establish a posteriori models of forest and agricultural management.
\r\n\r\n\tFor this, the methodological approaches on the type of sampling are considered essential, since there are differences between the purely ecological and the phytosociological methods, despite the fact that both pursue the same objective.
\r\n\tAlthough the ecological method for the knowledge of the vegetation is widely extended, the phytosociological one is no less so, since in the European Union it has been developed as a consequence of policies on sustainability, through which regulations have been issued, such as the habitats directive.
\r\n\tOn the other hand, research on plant dynamics and knowledge of the landscape in an integral way, have multiplied in the last 30 years, which has favored a deep knowledge of the floristic and phytocenotic wealth, which is fundamental for agricultural management, livestock and forestry.
",isbn:"978-1-83969-386-1",printIsbn:"978-1-83969-385-4",pdfIsbn:"978-1-83969-387-8",doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"0abf2a59ee63fc1ba4fb64d77c9b1be7",bookSignature:"Dr. Eusebio Cano Carmona, Dr. Ricardo Quinto Canas, Dr. Ana Cano Ortiz and Dr. Carmelo Maria Musarella",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9662.jpg",keywords:"Climatic Factors, Bioclimate, Thermotype, Flora, Conservation, Phytocenosis, Plant Dynamics, Landscape, Cartography, Vegetation Series, Crops, Reforestation",numberOfDownloads:55,numberOfWosCitations:0,numberOfCrossrefCitations:0,numberOfDimensionsCitations:0,numberOfTotalCitations:0,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"November 23rd 2020",dateEndSecondStepPublish:"January 25th 2021",dateEndThirdStepPublish:"March 26th 2021",dateEndFourthStepPublish:"June 14th 2021",dateEndFifthStepPublish:"August 13th 2021",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,biosketch:"Dr. Cano Carmona and colleagues have directed 12 doctoral theses and more than 200 publications among articles, books, and book chapters. He has participated in national and international congresses with about 250 papers. He has held a number of different academic positions, including Dean of the Faculty of Experimental Sciences at the University of Jaen, Spain, and founder and director of the International Seminar on Management and Conservation of Biodiversity.",coeditorOneBiosketch:"Ricardo Jorge Quinto Canas is currently an Invited Assistant Professor in the Faculty of Sciences and Technology at the University of Algarve – Portugal, and a member of the Centre of Marine Sciences (CCMAR), University of Algarve. His current research projects focus on Botany, Vegetation Science (Geobotany), Biogeography, Plant Ecology, and Biology Conservation, aiming to support Nature Conservation.",coeditorTwoBiosketch:"Ana Cano Ortiz's fundamental line of research is related to botanical bioindicators. She has worked in Spain, Italy, Portugal, and Central America. It presents more than one hundred works published in various national and international journals, as well as books and book chapters; and has presented a hundred papers to national and international congresses.",coeditorThreeBiosketch:"Carmelo Maria Musarella is a biologist, specialized in Plant Biology. He is a member of the permanent scientific committee of the International Seminar on “Biodiversity Conservation and Management” guested by several European universities. He has participated in several international and national congresses, seminars, and workshops and presented oral communications and posters.",coeditorFourBiosketch:null,coeditorFiveBiosketch:null,editors:[{id:"87846",title:"Dr.",name:"Eusebio",middleName:null,surname:"Cano Carmona",slug:"eusebio-cano-carmona",fullName:"Eusebio Cano Carmona",profilePictureURL:"https://mts.intechopen.com/storage/users/87846/images/system/87846.png",biography:"Eusebio Cano Carmona obtained a PhD in Sciences from the\nUniversity of Granada, Spain. He is Professor of Botany at the\nUniversity of Jaén, Spain. His focus is flora and vegetation and he\nhas conducted research in Spain, Italy, Portugal, Palestine, the\nCaribbean islands and Mexico. As a result of these investigations,\nDr. Cano Carmona and colleagues have directed 12 doctoral theses\nand more than 200 publications among articles, books and book\nchapters. He has participated in national and international congresses with about\n250 papers/communications. He has held a number of different academic positions,\nincluding Dean of the Faculty of Experimental Sciences at the University of Jaen,\nSpain and founder and director of the International Seminar on Management and\nConservation of Biodiversity, a position he has held for 13 years. He is also a member of the Spanish, Portuguese and Italian societies of Geobotany.",institutionString:"University of Jaén",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"5",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"University of Jaén",institutionURL:null,country:{name:"Spain"}}}],coeditorOne:{id:"216982",title:"Dr.",name:"Ricardo Quinto",middleName:null,surname:"Canas",slug:"ricardo-quinto-canas",fullName:"Ricardo Quinto Canas",profilePictureURL:"https://mts.intechopen.com/storage/users/216982/images/system/216982.JPG",biography:"Ricardo Quinto Canas, Phd in Analysis and Management of Ecosystems, is currently an Invited Assistant Professor in the Faculty\nof Sciences and Technology at the University of Algarve, Portugal, and member of the Centre of Marine Sciences (CCMAR),\nUniversity of Algarve. He is also the Head of Division of Environmental Impact Assessment - Algarve Regional Coordination\nand Development Commission (CCDR - Algarve). His current\nresearch projects focus on Botany, Vegetation Science (Geobotany), Biogeography,\nPlant Ecology and Biology Conservation, aiming to support Nature Conservation.\nDr. Quinto Canas has co-authored many cited journal publication, conference articles and book chapters in above-mentioned topics.",institutionString:"University of Algarve",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"3",totalChapterViews:"0",totalEditedBooks:"0",institution:null},coeditorTwo:{id:"203697",title:"Dr.",name:"Ana",middleName:null,surname:"Cano Ortiz",slug:"ana-cano-ortiz",fullName:"Ana Cano Ortiz",profilePictureURL:"https://mts.intechopen.com/storage/users/203697/images/system/203697.png",biography:"Ana Cano Ortiz holds a PhD in Botany from the University of\nJaén, Spain. She has worked in private enterprise, in university\nand in secondary education. She is co-director of four doctoral\ntheses. Her research focus is related to botanical bioindicators.\nDr. Ortiz has worked in Spain, Italy, Portugal and Central America. She has published more than 100 works in various national\nand international journals, as well as books and book chapters.\nShe has also presented a great number of papers/communications to national and\ninternational congresses.",institutionString:"University of Jaén",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"6",totalChapterViews:"0",totalEditedBooks:"0",institution:{name:"University of Jaén",institutionURL:null,country:{name:"Spain"}}},coeditorThree:{id:"276295",title:"Dr.",name:"Carmelo Maria",middleName:null,surname:"Musarella",slug:"carmelo-maria-musarella",fullName:"Carmelo Maria Musarella",profilePictureURL:"https://mts.intechopen.com/storage/users/276295/images/system/276295.jpg",biography:"Carmelo Maria Musarella, PhD (Reggio Calabria, Italy –\n23/01/1975) is a biologist, specializing in plant biology. He\nstudied and worked in several European Universities: Messina,\nCatania, Reggio Calabria, Rome (Italy), Valencia, Jaén, Almeria\n(Spain), and Evora (Portugal). He was the Adjunct Professor\nof Plant Biology at the “Mediterranea” University of Reggio\nCalabria (Italy). His research topics are: floristic, vegetation,\nhabitat, biogeography, taxonomy, ethnobotany, endemisms, alien species, and\nbiodiversity conservation. He has authored many research articles published in\nindexed journals and books. He has been the guest editor for Plant Biosystems and a\nreferee for this same journal and others. He is a member of the permanent scientific\ncommittee of International Seminar on “Biodiversity Conservation and Management”, which includes several European universities. 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Pursuant to data collected by the National Police Headquarters 8579 suicide attempts have been reported, 6101 of which ended in death in the year 2013. The three main determined reasons for the suicides were family discord (n=999), mental illness (n=797) and chronic disease (n=570), and in the majority of cases investigators failed to determine the reasons behind the suicide attempt (n=3,663) [2]. Available literature suggests that the occurrence of a chronic disease is associated with increased vulnerability to suicidal behaviour [3]. The chronic nature of epilepsy, numerous limitations resulting from the disease, myths regarding the disease itself and persons affected by it as well as stigmatisation of patients all adversely affect the patients’ well-being and quality of life [74]. Decreased self-esteem may in turn result in the occurrence of suicidal thoughts [4]. The aim of this paper is to describe epidemiological data and present risk factors for suicidal behaviour in patients with epilepsy. Taking these aspects into account in the treatment and secondary prevention regarding epileptic patients can help reduce that risk.
\nEstimates from an 8-year observation period of epileptic patients confirm that 30% of patients die in accidents, 23% die suddenly, 16% die as a result of an epileptic seizure and 14% commit suicide [5].
\nPublication | \nCountry | \nObservation period (in years) | \nNumber of deaths | \nNumber of suicides | \nPercentage of suicides | \n
---|---|---|---|---|---|
Cockerell et al. [10] | \nEngland | \n8 | \n792 | \n1 | \n0.13% | \n
Currie et al. [11] | \nEngland | \n7 | \n666 | \n3 | \n0.45% | \n
Elwes et al. [12] | \nEngland | \n11 | \n102 | \n1 | \n0.98% | \n
Hennessy et al. [13] | \nEngland | \n20 | \n299 | \n1 | \n0.33% | \n
Lhatoo et al. [14] | \nEngland | \n11.8 | \n792 | \n1 | \n0.13% | \n
Lindsay et al. [15] | \nEngland | \n13 | \n100 | \n1 | \n1.00% | \n
Lip et al. [16] | \nEngland | \n5 | \n1000 | \n3 | \n0.30% | \n
White et al. [17] | \nEngland | \n26 | \n1980 | \n21 | \n1.06% | \n
Bladin [18] | \nAustralia | \n4 | \n110 | \n1 | \n0.91% | \n
McIntosh et al. [19] | \nAustralia | \n10 | \n325 | \n4 | \n1.23% | \n
Ding et al. [20] | \nChina | \n2.5 | \n2455 | \n4 | \n0.16% | \n
Dalby [21] | \nDenmark | \n16 | \n346 | \n2 | \n0.58% | \n
Lühdorf et al. [22] | \nDenmark | \n4 | \n249 | \n1 | \n0.40% | \n
Olesen et al. [23] | \nDenmark | \n10 | \n6780 | \n422 | \n6.22% | \n
Aikiä et al. [24] | \nFinland | \n>1 | \n105 | \n1 | \n0.95% | \n
Iivanainen and Lehtinen [25] | \nFinland | \n76 | \n1481 | \n13 | \n0.88% | \n
Jutila et al. [26] | \nFinland | \n11 | \n140 | \n1 | \n0.71% | \n
Sillanpaa and Shinnar [27] | \nFinland | \n20 | \n233 | \n1 | \n0.43% | \n
Loiseau et al. [28] | \nFrance | \n1 | \n804 | \n1 | \n0.12% | \n
Shackleton et al. [29] | \nNetherlands | \n28 | \n1355 | \n7 | \n0.52% | \n
Rafnsson et al. [7] | \nIceland | \n5 | \n244 | \n4 | \n1.64% | \n
Fukuchi et al. [5] | \nJapan | \n14 | \n1722 | \n6 | \n0.35% | \n
Camfield et al. [30] | \nCanada | \n8 | \n692 | \n3 | \n0.43% | \n
Garcia-Flores [31] | \nMexico | \n20 | \n112 | \n5 | \n4.46% | \n
Guldvog et al. [32] | \nNorway | \n36 | \n64 | \n2 | \n3.13% | \n
Krohn [33] | \nNorway | \n10 | \n107 | \n3 | \n2.80% | \n
Stepien et al. [34] | \nPoland | \n9 | \n54 | \n2 | \n3.70% | \n
Zielinski [35] | \nPoland | \n2 | \n6710 | \n16 | \n0.24% | \n
Forsgren et al. [36] | \nSweden | \n7 | \n296 | \n1 | \n0.34% | \n
Nilsson et al. [6] | \nSweden | \n9 | \n6880 | \n26 | \n0.38% | \n
Chen et al. [37] | \nTaiwan | \n10 | \n263 | \n2 | \n0.76% | \n
Tsai [38] | \nTaiwan | \n1 | \n1224 | \n3 | \n0.25% | \n
Blumer et al. [39] | \nUSA | \n12 | \n10,739 | \n5 | \n0.05% | \n
Day et al. [40] | \nUSA | \n14 | \n10,030 | \n2 | \n0.02% | \n
Foldvary et al. [41] | \nUSA | \n22 | \n79 | \n1 | \n1.27% | \n
Freytag and Lindenberg [42] | \nUSA | \n11 | \n294 | \n9 | \n3.06% | \n
Quigg et al. [43] | \nUSA | \n7 | \n107 | \n3 | \n2.80% | \n
Hauser et al. [44] | \nUSA | \n39 | \n618 | \n3 | \n0.49% | \n
Mendez et al. [45] | \nUSA | \n8 | \n1611 | \n4 | \n0.25% | \n
Salanova et al. [46] | \nUSA | \n15 | \n215 | \n2 | \n0.93% | \n
Sperling et al. [47] | \nUSA | \n4.5 | \n583 | \n2 | \n0.34% | \n
Kelemen et al. [48] | \nHungary | \n6 | \n94 | \n1 | \n1.06% | \n
D’Alessandro et al. [49] | \nItaly | \n5 | \n161 | \n1 | \n0.62% | \n
Frequency of suicides in the deaths of epileptic patients.
The risk of suicide in patients with epilepsy is greater than in the general population. The standardised mortality ratio (SMR) for suicides in patients with epilepsy as compared with the general population ranges from 3.5 to 5.8 [6, 7]. Based on a review of 21 studies, it has been estimated that on average 11.5% (0–67%) deaths of epileptic deaths are due to suicide [8].
\nAvailable epidemiological data indicate that the risk of suicides committed among epileptic patients is ca. 3–10 times greater compared to the general population. However, some researchers believe that this risk can be even greater, up to 25 times more in certain types of disease, e.g. in patients diagnosed with temporal lobe epilepsy [9]. Table 1 summarises the number of deaths resulting from suicide when compared to all deaths among patients diagnosed with epilepsy within studies conducted in different countries.
\nThe epidemiological data presented in Table 1 differ substantially depending on the country and the area of the world. This results from the observation period and the population of epileptic patients.
\nThe motives behind suicide attempts in patients with epilepsy include factors characteristic for both the general population and factors typical of this disease.
\nRisk factors for suicide attempts have been listed by Patterson in the following abbreviation: SAD PERSONS—S, Sex (male); A, Age (elderly or adolescent); D, Depression; P, Previous suicide attempts; E, Ethanol abuse; R, Rational thinking loss, psychosis; S, Social support lacking; O, Organised plan to commit suicide; N, No spouse; S, Somatic sickness [3].
\nThe above-mentioned risk factors for suicide are confirmed by other authors, adding to that list suicide attempts in the family and in the immediate environment, mental disorders, including anxiety apart from depression [8, 50, 51], white race, self-inflicted injury in the interview, and alcohol abuse [52].
\nTaking into account patients suffering from chronic diseases, the risk factors for suicide attempts include stigmatisation, discrimination, taking medication that possibly induces depression and easy access to toxic drugs [53]. Specific risk factors for suicide in epileptic patients can be grouped into several major categories.
\nAdditional risk factors in epileptic patients are related to the type of epileptic seizures. The risk of suicide attempts increase in the case of simple partial seizures, in primarily and secondarily generalised seizures with regard to partial complex seizures and temporal lobe epileptic seizures in male patients [54]. Furthermore, more frequent seizures, regardless of their type and the age at which the patient was diagnosed with epilepsy, also constitute risk factor for suicide attempts [9]. Additionally, it was found that the risk of suicide is over 5 times higher in patients with a 6-month history of the disease and that this risk decreases with the disease duration [55]. A study conducted in Finland among children below 16 years of age diagnosed with idiopathic or cryptogenic epilepsy reported two cases of suicide (where n = 122), however such self-destructive behaviour was not observed in children with symptomatic epilepsy [56].
\nIt was also found that previous suicide attempts among epileptic patients increases the risk of another suicide in the future by ca. 38.4% when compared to the general population [57]. Similar results were obtained in a study conducted in Sweden, where that percentage amounted to 46.2%. Interestingly enough, not only epileptic patients are characterised by increased risk of suicide, but there is also a 5-times greater risk of epilepsy in persons who attempted to commit suicide prior to their diagnosis [58]. It is worth noting that this risk was not associated with the incidence of depressive disorders and alcohol abuse. Deterioration of cognitive functions and personality disorders resulting from the frequency of seizures increase the risk of suicide attempts [59].
\nMany researchers are convinced that the main risk factor for suicidal thoughts in epileptic patients is co-morbid depression and other mental disorders. A study conducted in Canada demonstrated that during the lifetime of epileptic patients as compared with the general population, the following occur more often: depression (17.4% vs 10.7%), anxiety disorders (22.8% vs 11.2%) and suicidal thoughts (25% vs 13.3%) [60]. This was confirmed by results of a study conducted in Denmark on a group of 492 patients with epilepsy who committed suicide, as compared with the control group. It was proven that the risk of suicide increases over 29 times when an epileptic patient also suffer from a mental illness. In the same study, it was calculated that the risk of suicide in epileptic patients increases almost twofold in the case of a history of a mental illness [55]. It was found that in women suffering from epilepsy and with a history of mental illness, the risk of committing suicide is 23 times greater than in the case of women without these two conditions, and in comparison with men suffering from both epilepsy and a mental disease, that risk is 10 times higher [55].
\nIt was also estimated that the risk of suicide in patients with epilepsy increases almost 14 times in the case of the co-morbidity of mental disorders, including 32 times more in the case of mood disorders and 12 times more in anxiety disorders [55]. Similarly, a study conducted in Sweden showed that co-morbidity of epilepsy with mental disorders is related to 9 times greater increase of suicide risk [6]. The MEPSY study carried out among Korean patients demonstrated that risk factors for suicide among epileptic patients include advanced depression (OR = 6.448; 95% CI = 3.739–11.120; p <0.001), generalised anxiety disorder (OR = 3.561; 95% CI = 1.966–6.452; p <0.001), as well as history of febrile seizures (OR = 2.188; 95% CI = 1.318–3.632; p = 0.002) [61]. Kanemoto et al. [62] observed a greater risk of suicide attempts in patients with temporal lope epilepsy who experienced psychotic episodes (7%) than during acute interictal psychosis (2%) or post-stroke confusion (0%).
\nRisk factors for attempted suicide in adult epileptic patients also include emotional disorders [63]. Buljan et al., a study carried out among hospitalised patients, have shown that next to mental disorders, another statistically significant risk factor for suicide attempts in epileptic patients is also a difficult family situation. The authors have estimated that 14.6% patients treated in Croatia attempted to commit suicide for that reason [50]. Results of the Hawton et al. [75] paper indicate a much higher percentage of suicide attempts among patients with epilepsy who have trouble finding employment. A multivariate analysis of logistic regression has confirmed that unemployment (Exp (B) 33.9; p = 0.007) is associated with suicidal thoughts in epileptic patients treated in Bosnia and Herzegovina, as is the sense of hopelessness (Exp (B) 14.9; p = 0.001) [64].
\nApart from current or past co-morbidity with psychiatric disorders, other risk factors include the use of anti-psychotics and the first instance of a seizure before 18 years of age [65]. In January 2008, the Food and Drug Administration (FDA) alerted that the use of anti-epileptic drugs (AEDs) is associated with an increased risk of suicide in patients who use them. FDA conducted an analysis of 199 placebo-controlled randomised studies on the risk of suicide attempts in connection with the use of 11 anti-epileptic drugs. The study included 27,863 patients treated with AEDS and 16,029 patients administered with placebo. Each group included at least 20 people treated for at least 7 days. The analysis included 25% of patients diagnosed with epilepsy, 27% of patients with mental disorders and 46% suffering from pain associated with the disease. Committed suicide was reported in four patients taking AEDs vs none patients in the placebo group; a suicide attempt was reported in 30 vs 8 persons, respectively, and suicidal thoughts were reported in 67 vs 29 persons, respectively. Relative risk of suicide for patients treated with AEDs vs placebo was 3.5 for people suffering from epilepsy, 1.5 for people with mental disorders and 1.9 for the remainder of the study group. FDA has concluded that patients using anti-epileptic drugs have a higher risk of suicidal thoughts and behaviour than the population taking a placebo [66].
\n\nIn another study conducted on a population of 269,937 people aged ≥15 years of age, treated with anti-epileptic drugs, 26 suicides, 801 suicide attempts and 41 sudden deaths were reported. It was estimated that the risk of suicide behaviour was lower in patients using topiramate than in patients using gabapentin, lamotrigine, oxcarbazepine or tiagabine. However, an elevated risk of a sudden death occurred in a group of younger and older patients using gabapentin, in patients with mood disorders and epilepsy as compared with a group taking carbamazepine [67].
\n\nA study conducted on a group of 131,178 patients with epilepsy, pain, bipolar disorder, depressive disorder and schizophrenia demonstrated no difference in the risk of suicide for people using gabapentin [68].
\nAnother study conducted in the United Kingdom compared 453 epileptic patients treated with AEDs with 8962 people in a control group matched in terms of age and gender. The anti-epileptic drugs used were classified into four groups: barbiturates, conventional AEDs, new generation AEDs with a low (lamotrigine, gabapentin, pregabalin, oxcarbazepine) or high (levetiracetam, tiagabine, topiramate, vigabatrin) depression-inducing effect. It was found that new generation AEDs with a high depression-inducing effect increased the risk of self-inflicted injuries/suicidal behaviours, it was however obvious only in patients with co-morbid mental disorders [69]. Yet another study shows that the use of barbiturates is associated with inducing depressive symptoms, which may lead to abnormal behaviour, depression and suicidal thoughts, particularly in children [70].
\nDrug | \nMechanism of action | \nRisk of suicide | \n
---|---|---|
Phenobarbital | \nEffect on GABA No effect on glutamate No effect on serotonin | \nProven suicidality risk | \n
Phenytoin | \nEffect of Na+ channels No effect on glutamate No effect on serotonin | \nProven suicidality risk | \n
Carbamazepine Oxcarbazepine Valproate Lamotrigine | \nImprove cognitive functions and mood in epileptic patients, and effect on serotonin | \nAntisuicidal properties | \n
Topiramate Tiagabine Vigabatrin Levetiracetam | \nExert negative effects on mood and cognition, and no effect on serotonin | \nInfluence on suicidality has not been proven in evidence-based studies yet | \n
Zonisamide | \nExert negative effects on mood and cognition, but effect on serotonin | \nInfluence on suicidality has not been proven in evidence-based studies yet | \n
Gabapentin | \nExert positive psychotropic effects on mood and cognition, but no effect on serotonin | \nAntisuicidal properties | \n
Antiepileptic drugs and risk of suicide [71].
A study based on data from the Danish National Prescription Registry concerning 169,725 AEDs (only 2.6% of prescribed for epilepsy treatment) confirmed increased risk of suicide (OR = 1.85; 95% CI = 1.4–2.5), in particular in patients treated with clonazepam, valproic acid, luminal and lamotrigine [23].
\nFurthermore, it was indicated that the use of anti-epileptic drugs in polytherapy is also a factor in the risk of suicide [65].
\nOn the one hand, some AEDs can cause depression, which itself is the main risk factor for suicidality, but on the other hand, other AEDs have effect similar to antidepressants, and these properties exert antisuicidal effect. The AEDs differ mechanism of action, influence on cognition and mood in epileptic patients and suicidality. Probably, serotonin may play a role in the mechanism of action of some antiepileptic drugs. AEDs with serotonergic properties should reduce the suicidality risk, because they exert effects similar to antidepressants. Perhaps, psychotropic effects of AEDs may be the result of effects on the receptor functions: γ-gamma-aminobutyric acid (GABA) ergic and antiglutamatergic and neurochemical mechanisms [71]. Table 2 shows the influence of some AED on suicide risk.
\nNot much data are available on the risk of suicidal attempts in a group of patients subjected to surgical treatment of epilepsy. A study that involved the observation of 396 patients subjected to surgical treatment of epilepsy indicates that 4 of the 27 reported deaths were caused by suicide, despite good control of epileptic seizures [72]. An analysis of the period which lapsed from the surgery indicates that the risk of a suicide attempt is greatest during the first 6 months after the surgical intervention [73].
\nDuring the past few years, a number of studies have been published trying to examine the correlation between AEDs and suicide. However, relationships between suicidal behaviour and AEDs are unclear, show a lack of concordance and are affected by a number of limitations (e.g., observational studies, more than one risk factor in patients with epilepsy).
\nAn essential element of addressing this subject is to know all the possible risk factors for suicide attempts resulting both from the disease itself and additional causes in order to prevent suicide in epileptic patients effectively and in a timely manner. When conducting an interview, neurologists should pay special attention to whether the patient or his/her family has additional mental issues or whether any prior suicide attempts had been reported in the patient or his/her family. Additionally, when monitoring the treatment progress, it is necessary to verify the symptoms of depressed mood, in particular if the patient uses new generation anti-epileptic drugs, which can cause depression. A significant preventive factor also includes assessing the patient’s social relationships (family, friends and work), in particular emotional problems, which can significantly impact suicide attempts.
\nEach time the creation and refinement of new material growth techniques give rise to the finding of new equipment. The semiconductor which has been found to be most interesting of all (when used), relates to the applications in electronic devices for instance, high speed circuits formed of group III-V compounds along with switches or amplifiers. One of the types of is the Gallium Arsenide (GaAs) [1, 2]. A III-V semiconductor that it is, its composition includes gallium which is an element of the group 3 having orthorhombic trigonal crystal structure coupled with arsenic which belongs to the group 5 and has a trigonal crystal structure. This very combination leads to interesting physical as well as chemical properties in this semiconductor [3, 4]. With different electronic band gaps, these semiconductors can, at ambient temperatures, crystalize into a zinc-blende cubic type crystal structure. Post the discovery of transistor in the year 1947, Gallium arsenide (GaAs) has presented itself as a prominent material for electronic devices. The technological importance and the need of study of Gallium arsenide (GaAs) in the last few years are due to its high melting point at 1238
GaAs is the basis of a worldwide industry it has a wide usage area changing from microwave frequency integrated circuits to optical windows. Among III-V semiconductors, GaAs has remained useful as a semiconductor material, widely being used in optoelectronic and microelectronic devices. Given this wide use of GaAs, the idea came to write this chapter focusing on the physical and chemical properties of this important material. While excluding the impurities present and their associated effects, the focus is on the characteristics of GaAs [7, 8].
Included in this chapter, are a few physical as well as chemical properties of gallium arsenide (GaAs) such as the crystal Structure, the direct bandgap of GaAs with its zinc blende type crystal structure, electronic structure, light-emitting properties, electromagnetic properties, photovoltaic properties, phase transition and mechanical as well as elastic properties. The geometric structures, stabilities, and electronic properties like higher saturated electron velocity and high carrier mobility with a small dielectric constant and high resistivity. This chapter also elaborates on the thermodynamic properties of GaAs such as thermal expansion and thermal conduction.
These great properties led to the production of new and unique devices like high-efficiency light emitters, light sensors, and high-speed switching devices. The GaAs is considered as an outstanding member of the III-V semiconductor family. It has many exceptional features, especially for the recent optoelectronic industry. Hence, special focus has been laid on the examination of physical properties of this material [9, 10, 11].
The band structure is the major part of the semiconductors. Briefly explaining it, at absolute zero, a bandgap or an energy gap separates the conduction band (lowest empty band) with the valence band (highest filled band). Therefore, at T = 0, electricity is not conducted by the material. The electrons are enabled to be excited into the conduction band through several processes, such as optical absorption or thermal excitation, at finite temperatures and electrical conduction is allowed as there are empty states in the valence band. Energy, in the forms of heat or photons, is released when the electrons return to the valence band [12, 13].
As mentioned in Figure 1, two types of bandgaps are there based on different conditions. The first one is if, over the top of the valence bond, the bottom of the conduction band does not rest. As a result of this, it is called an indirect gap. Also, photon is necessary in order to provide the momentum required to reach the state in the conduction band, and the electronic transition to happen. However, in case of GaAs and other direct band type semiconductor, the bottom of the conduction band site and the top of the valence band are on top of each other, Therefore even without a change in the wave vector, the electron is able to get excited from the valence band. A photon on absorbing required energy is sufficient enough for this. Moreover, through the emission of a photon, transition to the valence band from the conduction band can easily be done by the electron. While no interaction of photon is required, emission of light energy of the desired wavelength of 850 nm bandgap occurs and it allows the direct band recombination of holes and electrons. In the absence of defects, the energy released by the dominant mechanism of the indirect bandgap is by photons via electromagnetic radiation. However, photons release energy in the form of heat in the case of indirect bandgap semiconductors [14, 15, 16].
Schematic of the valence band, direct bandgap, and indirect bandgap conduction bands [
Being a good optoelectronic material, direct bandgap in GaAs is considered a useful material in the field of optoelectronics and other electronic fields and is used comprehensively in semiconductor lasers as well as light-emitting diodes. Its use has also been encouraged in the making of high-efficiency solar cells, Gunn diodes, Infrared LEDs, solid-state detectors and radar systems. We have a classification of 1–3 categories depending upon the magnitude of bandgap energy of the materials, namely, narrow, mid and wide-bandgap. Of all the properties of a semiconductor, the presence of energy gap leads all others [16, 17].
Not only band-gap engineering permits the making of band diagrams that have continuous as well as arbitrary band-gap variations, but it is also considered among the strongest tools for the new semiconductor devices and materials. For a specific application, the transport properties of holes, as well as electrons, may be continuous and independent. This approach leads us to a new generation of devices having unique capabilities ranging from resonant tunneling transistors to solid-state photomultipliers. More than for any semiconductor, many band structures for GaAs are precisely known. Figures 2 and 3 make it clear, showing 1.519 eV as the fundamental energy gap for Gallium Arsenide. Also, the high-temperature performance of GaAs is largely attributed to its wide bandgap [20, 21, 22].
Structure of GaAs energy band gap [
(a) Calculated band structure of GaAs using the tight binding method. (b) Sketch of GaAs band structure near the Γ-symmetry point showing conduction band, heavy hole band (hh), light hole band (lh), and split-off band (so) in the X [100] and L [
Other than this, photoconductivity, a feature semiconductor exhibit under suitable trial conditions is another benefit associated with the bandgap [23]. This occurs when an increase in electrical conductivity happens when an incident light falls on a semiconductor. The suitability of the semiconductor material in optoelectronic devices is also decided by its photoconductive response. Such materials which respond well to the photoconductivity, find themselves useful in the making of infrared sold state detectors. Also, in GaAs, the transport properties of hot electrons are largely affected due to the bandgap. Alloying is another controllable bandgap which useful property of the GaAs [22, 24, 25, 26].
The usefulness of GaAs and its alloys in optoelectronics such as sold state lasers and LEDs lies in the bandgap of GaAs which, in the infra-red range results in the emission of photon. The ability of GaAs to retain their semiconductor properties at high temperatures, giving stability to the GaAs comes from the wider bandgap of GaAs [19]. Figure 3 shows that Calculated band structure of GaAs using the tight binding method with different semiconductor materials.
That GaAs is an extremely poor conductor is corroborated by the fact that GaAs has low flow intrinsic carrier density when present in an undoped or pure form. Hence it is mostly considered as semi-insulating. Adding the dopants of either the p- or the n- that is the positive and the negative types respectively, alters this property. Many active devices have been able to be made on a single substrate due to this semi-insulating property, where each device’s electrical isolation is provided by the GaAs. For contraction of the electronic circuitry, this characteristic has been found be quite important [27, 28].
With regards to the transport properties, two important questions that come up where the incorporation of dopants has been done – a) mobility, b) effective carrier concentration [29, 30].
The conductivity is given by
Eq. (1) and Figure 4 can be used to understand the effect of temperature on the concentration of the carrier. It shows the entry of temperature in both exponential as well as pre-exponential terms. There are two effects of increased temperature [31, 32]:
the effective density of states of the edge of the band is increased (
the exponential portion of Eq. 10 shows a decrease, since its denominator is T.
Bandgap energy inverse T for Ge, Si, GaAs in the range 200–1000 K. T [
In solid-state physics, the central theoretical problem happens to be the determination of the energy bands. In other words, in case of solids, the central theoretical problem is the calculation of energy levels of electrons. In order to calculate physical properties such as mechanical properties, magnetic order, optical dielectric or the vibrational spectra, in principle knowledge of the electrons and the energies associated with them is required. In contrast, calculation of lattice constants and other bulk ground state properties such as atomic positions and bulk modulus is considered to be important in physics associated with condensed matter. Such bulk calculations not only help understand as well as characterize the mechanical properties of the matter, but they also help predict their properties in extreme conditions [33, 34, 35].
Having a basis and a cubic lattice that is two face centered, the structure of crystal of GaAs is a zincblende structure or cubic sphalerite. In the classic basis, at the origin of the lattice, there is one GaAs molecule. From (0,0,0), the vector of one atom to another at (1/4,1/4,1/4) of the molecule constitutes the basis. Two FCC lattices, one of as while the other being of Ga can also form a crystal as shown in Figure 5. While arsenic atoms are represented in orange color, the Gallium ones are shown in purple color. As shown, there are 4 arsenic atoms against 14 gallium atoms. This makes a tetrahedral bond, similar to the one in a diamond lattice, but replaced with Ga and as where each Ga is connected to four other atoms. It shows ionic bonding with the presence of two types of atoms [37, 38, 39] (Figure 6).
P-V plot of GaAs up to 25 GPA [
The crystal structure of GaAs cubic unit cell of GaAs [
Figure 7 shows that the drawing of the energy band of the semiconductor, which demonstrates the bandgap along with valence and conduction electrons. An electron leaves a hole in the valence band on moving to the conduction band from the valence band. For the other electrons in the valence band energy levels, this hole is an empty state and behaves in a manner similar to a +
Room-temperature band gap energy, Eg, as a function of lattice constant for several semiconductors. Lines connecting binary compounds such as GaAs and AlAs represent alloy composition with either a direct band gap (thick solid line) or indirect band gap (thin red line). The III–V and II–VI semiconductor compounds in the figure have the zinc blende crystal structure. Si and Ge have the diamond crystal structure [
The density of holes in the valence band equals the density of electrons in the conduction band.
In the above formula,
T - temperature in K.
Reordering the above equation, we have
Taking log we have
Solving for
It is in the middle of the bandgap that we have the Fermi energy (
Band alignments for sever III-V semiconductor with GaAs. (a) Lattice constants and band gaps of different semiconductor materials. The lattice constants of Ge and GaAs are close to a variety of semiconductors with different band gaps, thereby commonly used as substrates for tandem cells. (b) Schematics of a triple-junction tandem cell with optimized compositions of InGaAs and InGaP, which correspond to the blue dots in (a). A buffer layer has to be applied to accommodate the lattice mismatch between the Ge substrate and In 0.17 Ga 0.83 As; (c) Proposed latticematched GeSn/InGaAs/InGaP tandem cell [
An ionic bond exists between the electrons in the valence band of GaAs atoms. Therefore, in solids, they are not free to transport. However, they can move through a solid if the electron gets excited to the conduction band. Hence, an electron leaves a hole in the valence band on moving to the conduction band from the valence band. An electron jump from one bond to another enables the hole to move in the valence band. Further, these holes and electrons can move upon affected by an electric field [43, 44, 45].
The equation that helps derive the acceleration of the electrons (ae) is-
Where
In the case of an electron in a solid, under an external field, the interaction with the solid atoms should also be taken into account. Let this interaction of electrons with the atoms of the solid be summed up as
The conduction electrons are initially in the lowest energy valley, Γ minimum. Here, they are distinguished by a low effective mass and have high mobility. On applying the electric field, these electrons are rapidly accelerated by the field to high velocities: they gain kinetic energy. The electrons’ ability gains enough energy to transfer from this valley to the next higher valley, the L minimum. These upper valleys are distinguished by a larger effective mass, and consequently both lower electron mobility and a greater density of available electron positions. The great density of states encourages transfer to these valleys of electrons with suitable energy. There is a fall in the average velocity of all the electrons as the energetic electrons transfer to the upper levels. There is much work available which is focused on the calculation of hot electron transport properties in GaAs. Gallium arsenide exhibits the `transferred electron’ which is commonly known as the TE effect. This transfer of electrons from one region to another energy band structure is an electric-induced field transfer. It has high electron mobility, with a negative resistance being observed and has a small dielectric constant. This is primarily because of extensive utilization of GaAs in ultrahigh frequency, high-temperature resistance and low power circuits and devices [48, 49, 50, 51, 52, 53].
There are two main categories in which the optoelectronic devices can be categorized. First is the set of those devices in which electrical current get converted into electromagnetic radiation i.e. light. Second is the set of those devices in which light is converted into electric current. An example of the first category of devices is the LEDs. Optoelectronic devices as well as light-emitting devices have GaAs in them. Macroscopic evidence is available for the interaction of matter with light and it is made of four components, namely, incident, reflected, transmitted, and scattered component [52, 54, 55].
Absorption of a photon in a semiconductor can happen in a number of ways. This is commonly known as interbond absorption. This happens when in the conduction band an electron is excited up after having absorbed a photon in the valence band. The momentum is unchanged in case of direct gap semiconductor while there is an increase in electron’s energy. The momentum is though shifted in case of an indirect gap material. This is made possible by a decrease in bandgap energy with the increase in temperature and a photon being either absorbed or emitted. The two factors responsible for this are lattice vibration (phonons) and thermal expansion. The increase of lattice constant is due to the thermal expansion. This further leads to the change in the periodic potential as seen by the electron. The band structure is altered due to these changes [56, 57, 58, 59].
Temperature and bandgap shift are related as per the following formula
where
Eg - band gap energy
T - temperature
Eg (0) - bandgap at 0 K having units same as that of energy
α has units the same as that of temperature/energy.
Prominently used in optoelectronic as well as microelectronic devices, Gallium arsenide, GaAs is considered a good semiconducting material, having high electron mobility. In the semiconductor material, through the interaction of electron and photons, sunlight is converted into electricity directly by photovoltaic cells [60, 61, 62].
Electronic excitation of luminescence is the reason, it is also called as optical radiation. State energy is emitted in the form of EM radiation when the excited electrons move back to the ground. Depending upon the electronic excitation created originally, there are four different types of luminescence, namely,
The functioning of LEDs is by electroluminescence. Using a functional bias, electric current which includes holes and electrons are forwarded to the device. Light is emitted by the recombination of these holes and electrons. In order to increase efficiency, heterostructure LEDs are used. The holes and the electrons, collectively called the carriers are confined in a small spatial region in order to achieve this. Due to the localization of carriers in GaAs, there is higher quantum efficiency at the heterojunction. Hence, it is only in the i-GaAs region, that the recombination takes place. Figure 9 draws a clear picture of the emitted wavelength in case of both LEDs as shown in Figure 9 [63, 64, 65, 66].
The heterojunction has a higher quantum efficiency since the carriers are localized GaAs [
The physical knowledge of the materials namely the phase transitions, interatomic forces and the mechanical features apart from many other features are better understood by examining the elastic properties of the material.
Being low-density materials, III-V compounds, under pressure, have the ability to show transitions of structural phase to a phase with higher density. Figure 3 clearly shows that with increase in pressure, the density of GaAs also increases [67].
Figure 5 shows the P-V graph which helps determine the B3 → B1 phase transition of GaAs. At 17 GPa there is an unexpected decrease in the GaAs’s volume. This decrease is attributed to the change in the structural phase related with phase transition of B3 → B1 [23, 36, 68, 69, 70, 71].
Gallium Arsenide is deemed as an eminent member of the III-V semiconductor group. It has presented itself as a notable material for electronic devices and vastly being used in optoelectronic and microelectronic devices. The precept knowledge of the electrons and the energies related to GaAs is required in order to calculate physical properties. Furthermore, calculation of lattice constants and other bulk ground state properties is considered to be paramount in physics associated with condensed matter.
In this chapter we have reported the basic principle for the GaAs material as well as the physical, optical, and chemical properties. Also, we have reported the crystal growth of the GaAs with another semiconductor material such as In and Al.
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