Suicide

Abstract

Suicide is a multidimensional concomitant of psychiatric diagnoses, especially mood disorders, and is complex in both its causation and in the treatment of those at risk. It has known risk and protective factors that tend to be fairly consistent worldwide, with some cultural variation. Even with standardised assessment and prediction scales (such as the Hamilton or Beck depression inventories), suicide prediction results in about 30% false positives. The most common biological marker of suicide is reduced concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid in the CSF of suicide cases versus controls. Although suicide prevention is ideally primary, in fact most treatment is secondary or tertiary. Dependent on the individual characteristics present, suicide prevention usually includes a pharmacological cocktail (especially one of the selective serotonin reuptake inhibitors, to raise serotonin concentrations, perhaps combined with an anxiolytic, mood stabilising, or antipsychotic agent), supportive psychotherapy (often cognitive or behavioural therapy), and sometimes electroconvulsive therapy. Perceived danger to self can necessitate treatment in hospital.