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 Risk factors SAD PERSONS Sex - male females attempt more, males succeed more Age - > 45 years Depression or other mental illness Previous suicide attempts Ethanol/substance abuse Rational thoughts/Race whites at higher risk Sickness - chronic illness Organized plan/access to weapons No spouse marriage is protective children of divorced parents at risk Social support lacking / Socioeconomic class upperclass professionals at increased risk Presentation Symptoms complaints of suicide demonstration of suicidal behavior giving away possessions, writing a will, or buying materials for suicide Evaluation 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 Nonpharmacologic electroconvulsive therapy - for severe risk of acute self-harm Pharmacologic antidepressants antipsychotic mood stabilizers Prognosis, Prevention, and Complications Prognosis best predictor of a future suicide attempt is a past attempt Complications suicide risk may increase after starting antidepressant therapy energy (to act on suicidal ideation) returns before mood symptoms