Suicide is a global public health problem that causes the loss of more than 800,000 lives each year, principally among young people. In Brazil, the average mortality rate attributable to suicide is approximately 5.23 per 100,000 population. Although many guidelines have been published for the management of suicidal behavior, to date, there are no recent guidelines based on the principles of evidence-based medicine that apply to the reality of suicide in Brazil. The objective of this work is to provide key guidelines for managing patients with suicidal behavior in Brazil. This project involved 11 Brazilian psychiatry professionals selected by the Psychiatric Emergencies Committee (Comissã o de Emergê ncias Psiquiá tricas) of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. For the development of these guidelines, 79 articles were reviewed (from 5,362 initially collected and 755 abstracts). In this review, we present definitions, risk and protective factors, assessments, and an introduction to the Safety Plan. Systematic review registry number: CRD42020206517

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eightyfive articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention.

Introduction: Emergencies in the pregnancy and postpartum are less frequent than in other groups, but not uncommon. However, the literature on the subject is scarce and controversial. Objective: The objective of this article is to present some recommendations for the management of the most common psychiatric emergencies that may occur in pregnancy or postpartum period. Method: These procedures were focused on the discussion and integration of the findings from peer-reviewed published research on the topic. We searched electronic database PubMed. Relevant abstracts were identified using the following search terms: Psychotropics medications at pregnancy and breastfeeding: (((psychotropic medications) AND (pregnancy)) OR (psychotropic medications)) AND (breastfeeding) - Psychiatric emergencies: (((((((psychiatric emergencies) AND (pregnancy)) OR (psychiatric emergencies)) AND (postpartum)) OR (psychiatric emergencies)) AND (peripartum)) OR (psychiatric emergencies)) AND (breastfeeding). Inclusion criteria included papers published (or in press) about pregnancy or breastfeeding or postpartum from December 2000 to January 2021 that focused on agitation in psychiatric emergencies.  Main Results:  We present recommendation for pharmacological treatment, psychomotor agitation, suicide behavior, psychotic disorders and mania, severe depression, and substance use disorders.  Conclusion: Although many of the recommendations are empirical, it is already possible to rely on information that provides better results and safety for the patient and her infant.

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