Suicide

The role of no-suicide contracts is but a small tactical piece of the larger strategic approach to the assessment and prevention of suicide. Its many obvious limitations-to some degree in assessment, but primarily in suicide prevention-should have driven serious discussion of no-suicide contracts out of consideration as a practical measure in clinical practice and a legal talking point in the courtroom.

Proper suicide assessment is probably the most important part of a clinician's job; appropriately, heavy emphasis is placed on this in our education. Unfortunately, psychiatrists receive comparatively little practical guidance in documenting the history and physical examination (H&P) of a suicidal patient.

González-Pinto A, Aldama A, González C, et al. Predictors of suicide in first-episode affective and nonaffective psychotic inpatients: five-year follow-up of patients from a catchment area in Vitoria, Spain. J Clin Psychiatry. 2007;68:242-247.

According to the CDC, in 2004, suicide was the 11th leading cause of death across all age groups and the 10th leading cause of death for persons aged 14 to 64 years; 32,439 people in the United States took their own lives. Women attempt suicide about 3 times more often than men, although men are 4 times as likely to complete suicide. Anderson and Smith3 reported that suicide was the eighth leading cause of death among men in 2001. Of the 24,672 completed suicides among men, 60% involved the use of a firearm (the use of a firearm was the means of suicide in 55% of all cases).

Assessing bullying behavior and suicide attempts in victims of bullying.

Although suicidal ideation occurs in roughly 5% to 14% of pregnancies,1 suicide attempts are relatively rare (0.04%) and are associated with substance abuse and poor pregnancy outcome.2 After a suicide attempt, the clinician must first consider the possibility of recurrence of self-destructive behavior by assessing the woman's motivation, her attitude toward the pregnancy, and the severity of her depressive symptoms.

Risk Factors for Suicide in Patients With Schizophrenia

Beyond demographic characteristics, risk and protective factors for suicide in older adults have been much more clearly defined in recent years by a series of methodologically rigorous, case-controlled psychological autopsy studies.

Concerns about senior suicide and the lack of geriatric mental health services took center stage at hearings in the Senate Special Committee on Aging on September 14. Geriatric psychiatrists reviewed unfavorable trends such as faltering numbers of medical school graduates going into primary care and already small numbers of geriatric psychiatrists getting even smaller.

Older adults have higher rates of suicide than younger adults in many industrialized nations.

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

Should physicians be allowed to assist in their patients' dying, and how can physician-assisted suicide be reconciled with the physician’s role as a healer?

The FDA advisories warning of increased suicide risk among children and adolescents beginning antidepressant therapy have alarmed the health care community--but it may actually be a disservice to withhold these medications from those who need them.

Aware that mental illness generally begins early in life and that four teenagers commit suicide every day, several organizations and agencies are stepping up efforts to expand voluntary mental health screening and suicide prevention initiatives for youth--but they are doing so in the face of stigma and vocal opposition.

Although lithium is still a first-line treatment for bipolar disorder, many psychiatrists are reluctant to use it due to blood monitoring requirements. The FDA has approved an in-office blood test that allows lithium blood levels to be obtained in minutes. The test is similar to glucose monitoring devices used for diabetes, and experts on BD are hoping it will increase the use of lithium, which has also been shown to lower the suicide rate among patients with this disorder.

A cross-cultural comparison of suicide in old age, including a discussion of recent epidemiological trends in suicide rates. The authors also discuss the impact of social and cultural variables on the detection of depression and the formulation of suicide prevention strategies.

Patients with borderline personality disorder are at a much higher risk for suicide attempts than patients with almost any other mental illness. Here, a case report and examples are presented to help clinicians assess, diagnose and treat patients with BPD who have attempted or are threatening suicide.

Since the introduction of the SSRIs in the early 1990s, the rate of antidepressant prescribing has increased dramatically. This look at five national data sets concludes that greater recognition of depression and greater rates of treatment with medication and psychosocial interventions has made a significant contribution to reducing suicide rates.

What role might cognitive functioning play in suicidal ideation in elderly patients? How can psychiatrists determine the cognitive functioning skills of older patients who express suicidal thoughts?

Euthanasia is a word coined from Greek in the 17th century to refer to an easy, painless, happy death. In modern times, however, it has come to mean a physician's causing a patient's death by injection of a lethal dose of medication. In physician-assisted suicide, the physician prescribes the lethal dose, knowing the patient intends to end their life.

According to a survey done in 1999, 54% of Oregon's psychiatrists and 75% of the state's psychologists supported physician-assisted suicide, whereas between 20% and 33% of all health care professionals opposed it. The debate continues, as the federal government is trying to take away prescribing privileges for physicians who prescribe life-ending medications.

Can PET scans show differences in suicide risk among depressed patients? What are the risk factors for high-lethality suicide attempts versus low-lethality attempts?

This summary of the special report looks at various new ways to assess and treat for suicidal ideation, risk and behavior.

Two of the most prevalent risk factors for suicide are family history of suicide and family history of psychiatric illness. Are these factors independent of each other? What role does genetics play? How can research in this area assist prevention programs?

Although studies have already shown that alcoholism can greatly increase the risk of suicide, a new published study has discovered that age is also a factor in suicide among alcoholics.

While the deaths of several students have figured prominently in recent news, studies show that college students actually have a lower rate of suicide than their nonstudent peers. What can be done to lower suicide rates even further?

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

Beyond the threat of malpractice suits, losing a patient to suicide can be one of the most profoundly disturbing experiences of psychiatrists' professional careers. Yet, there is sparse literature on the occurrence and scant attention given to it in residency training programs (Gitlin, 1999).

On May 3, U.S. Surgeon General David Satcher, M.D., launched a national plan to reduce the suicide rate in the United States. A collaborative effort by the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and the Health Resources and Services Administration, the National Strategy for Suicide Prevention maps out 11 goals and provides a blueprint for action on those goals.

This is the second part of an article series discussing the high risk of suicide attempts in patients with schizophrenia. Herbert Y. Meltzer, M.D., continues the discussion with treatment options and efficacy.