Snapshot A 47-year-old physician with a history of alcohol abuse and depression is transferred to the ER after being found on the floor of his apartment next to an empty bottle of oxycontin and a handle of whiskey. Prior to this event, he had been giving away large amounts of money and was very thorough in creating a will. Introduction 8th leading cause of death in US third leading cause ages 15-24 years EPIDEMIOLOGY Risk factors SAD PERSONS Sex - male login to view 1 more bullet Age - > 45 years Depression or other mental illness Previous suicide attempts Ethanol/substance abuse Rational thoughts/Race login to view 1 more bullet Sickness - chronic illness Organized plan/access to weapons No spouse login to view 2 more bullets Social support lacking / Socioeconomic class login to view 1 more bullet Presentation Symptoms complaints of suicide demonstration of suicidal behavior giving away possessions, writing a will, or buying materials for suicide STUDIES Take a suicide history must ask if patient is having suicidal thoughts or has a plan take all threats seriously detain and hospitalize do not identify with the patient do not leave patient unsupervised Treatment Hospitalization "contract of safety" have patient sign on admission regardless if patient refuses also includes self-injurious behavior with suicidal ideation cutting, burning, intentional harm Nonpharmacologic electroconvulsive therapy - for severe risk of acute self-harm Pharmacologic antidepressants antipsychotic mood stabilizers Complications Suicide risk may increase after starting antidepressant therapy energy (to act on suicidal ideation) returns before mood symptoms Prognosis Best predictor of a future suicide attempt is a past attempt