Assessing the risk of suicide

Historical perspective: A certain number of historical elements including t he progressive loss of religious values and the iaa that suicide is conside red to be an integral pari of medical knowledge must be taken into consider ation when assessing the risk of suicide. The sociological and psychoanalyt ical approaches attempt to help draw the suicidal subject out of the his/he r personal implication by affecting the social and subconscious aspects of the problem respectively. Other elements such as psychiatric, sociocultural , biological and psychopathological factors are also involved in evaluating the risk of suicide, Risk factors: Durkheim's analysis of the social, familial and occupational factors observed in suicide remains pertinent for assessing risk Psychiatri c disorders are also highly significant risk factors since some type of dis order is found in approximately 90% of ail suicide victims. Affective disor ders including rapidly alternating bipolar behavior, psychoses, particularl y schizophrenia, and borderline personality are the most frequently observe d, especially when associated with certain types of behavior such as drug o r alcohol abuse. The risk related to other factors such as suicidal behavio r (attempts or ideation) is independent of the psychiatric illness. For exa mple, the risk of successful suicide is 30 greater the year after an attemp ted suicide than in the normal population. Assessing risk: There are no known clinical means, notably psychometric, wh ich can successfully predict the imminence of suicide. Recent studies on br ain monoamine levels have shown that a lower 5-HIAA level does play some ro le in suicidal behavior, particularly violent suicide, although there is no predictive power for normality. It is important to recall that certain adv ances in the field of psychopathic illnesses offer new insight into concept s such as the death instinct and the suicidal act itself.