Crisis Concept Re-loaded?—The Recently Described Suicide-Specific Syndromes May Help to Better Understand Suicidal Behavior and Assess Imminent Suicide Risk More Effectively

Abstract

Background: Despite of the decreasing suicide rates in many countries, suicide is still a major public health concern worldwide. Traditional suicide risk factors have limited clinical predictive value, as they provide little reliable information on the acute psychological processes leading to suicide.Aims: The aim of this analysis is to describe and compare the recently introduced two suicide-specific syndromes [Acute Suicidal Affective Disturbance (ASAD) and Suicidal Crisis Syndrome (SCS)] with the classic psychological features of pre-suicidal crisis and also to assess the clinical utility of the new suicide prediction scales in contrast to classical risk factors.Method: Conceptual analysis.Results: Suicide-specific syndromes are not novel in terms of symptomatology or dynamics of symptom onset, but in their use of well-defined diagnostic criteria. In addition to symptomatic classification, they also provide an opportunity to objectively measure the current pre-suicidal emotional and mental state by validated tools.Limitations: Future studies need to be completed to prove the reliability and predictive validity of suicide-specific diagnostic categories and the related suicide risk assessment tools.Conclusion: Clinical use of suicide-specific syndromes is suggested. This transdiagnostic approach not only enables a more accurate and objective assessment of imminent suicide risk, but also facilitates research in neuroscience, which represent a major step forward in managing and complex understanding of suicidal behavior.

Psychotic depression and suicide risk: a mixed methods study

“…Some authors have called for a hierarchical classification of suicide risk factors. One classification of risk factors 50,51 differentiates between primary (mental disorders, clinical warning signs, previous and recent suicide attempt, recent or ongoing inpatient treatment), secondary (individual factors not directly related to mental illness, or have unclear associations to such behaviour), as opposed to tertiary (male gender, psychosocial, vulnerable periods etc.) risk factors.…”

The Mind After Midnight: Nocturnal Wakefulness, Behavioral Dysregulation, and Psychopathology

“…The Mind after Midnight hypothesis conceptualizes how disrupted or decreased sleep could contribute to psychiatric disorders and unsafe behaviors, and offers a unique opportunity for meaningful intervention. The Mind after Midnight hypothesis also integrates well with psychological models of acute behavioral risk, such as the Suicide Crisis Syndrome or Acute Suicidal Affective Disturbance ( Schuck et al, 2019 ; Voros et al, 2021 ).…”

Az öngyilkossági rizikó becslése a klinikai gyakorlatban.

“…Az öngyilkos viselkedés jelentősége és gyakorisága miatt szükségessé vált egy szuicidspecifikus diagnosztikus kategória bevezetése a pszichiátriai nómenklatúrába, illetve a mentális zavarokat osztályozó nagy diagnosztikai rendszerekbe [16]. A legújabb amerikai klasszifikáció, a DSM-5 rendszer függelékében már szerepel a szuicid viselkedészavar (szuicidal behavior disorder -SBD) a további kutatást indokoló állapotok között [17]. Kritériumai szerint az előző két évben történt öngyilkossági kísérlet esetében lehet megállapítani.…”

“…), és nem ad lehetőséget az akut rizikófaktorok és veszélyeztető tünetek felderítésére, valamint a jövőbeli szuicid viselkedés előrejelzésére sem [18][19][20]. Ez a kritérium (vagyis a két éven belüli öngyilkossági kísérlet), bár kétségtelenül jelentős rizikófaktor, de csupán egy múltbeli eseményt ír le, és nem ad információt az egyén aktuális állapotáról és az aktuális potenciális szuicid rizikó mértékéről [17].…”