Suicidal and violent behaviour in mood disorders: A major public health problem. A review for the clinician

Abstract

Suicide attempt, and particularly completed suicide are relatively rare events in the community, but they are very common among psychiatric patients. Since over 90% of suicide victims suffer from (mostly untreated) current major mental disorders (particularly from major depressive episode), psychiatric risk factors are the clinically most useful predictors, especially if psychosocial and demographic risk factors are also pesent. Violent behaviours associated with mood disorders constitute a related yet independently also important aspect of this illness, and assessment and management of violence is a key component of everyday psychiatric practice. While most people with current mental disorder are not violent, violence is more common among seriously mentally ill individuals than in healthy persons. This is particularly true for untreated schizophrenics and untreated patients with major mood disorders, first of all in the cases of comorbid substance use disorders, mainly among those with current mania or postpartum depression. Although specific clinical studies are lacking, it is very lilely that successful acute and long-tem treatment of mood disorders can reduce the risk of violent behaviour in this patient population.

Key Words::

• Suicide
• suicide attempt
• aggression
• violence
• criminality
• mood disorders

Acknowledgements

None.

Statement of Interest: Z. Rihmer has received speaker's honoraria from AstraZeneca, GlaxoSmithKline, Lilly, Lundbeck, Organon, Pfizer, Richter, Sanofi-Aventis, Servier-EGIS, and Wyeth Pharmaceuticals. He also received honoraria as a member of scientific advisory boards of AstraZeneca, Lilly, Organon, Pfizer, Richer, Sanofi-Aventis and Servier-EGIS. X. Gonda has received travel support from GlaxoSmithKline, Krka, Lilly, Montrose, Organon, Richter, Sanofi, and Schering-Plough. A. Rihmer has received travel support from, Lilly, Richter, and Sanofi. K. Fountoulakis is member of the International Consultation Board of Wyeth for desvenlafaxine and Servier for agomelatine and has received honoraria for lectures from AstraZeneca, Janssen-Cilag, Eli-Lilly and research grants from AstraZeneca and Pfizer Foundation.