Psychiatric Emergencies: Suicide and Violence

Abstract

In 2016, the overall global suicide rate was approximately 11 per 100,000 of the population. Suicide is more common in males. It is a particularly important cause of mortality in those aged 15 to 29 years, being a more common cause of death than road injury in females in that age range, and constituting the third leading cause of death in males in that age range (after road injury and interpersonal violence). Most cases take place in low- and middle-income countries. There is an association with unemployment, the season, several psychiatric disorders, and certain physical disorders, infections, and social stressors. The commonest methods of completed suicide are considered and the assessment and management of the potentially suicidal person are detailed. Most violent acts are perpetrated by men. Worldwide, approximately one in three women has been the victim of physical and/or sexual violence (mainly by an intimate partner), while one in two children aged between 2 and 17 years has suffered from violence in the previous year. Details are given of potential psychiatric causes of violent behavior. Neurochemical, neuro-endocrinological, structural cerebral, functional imaging, and neurospectroscopic findings are described. Details are given of the assessment of violence risk in psychiatric patients. The management of such patients is considered to recommended behavioral and environmental approaches, the verbal approach, patient–therapist relationship variables, and pharmacotherapy.