• D Cremniter, P G Despierre, and G Batista.
• Service de Psychiatrie, Hôpital Henri Mondor, Créteil.
• Presse Med. 1998 Dec 19; 27 (40): 215121562151-6.

Historical PerspectiveA certain number of historical elements including the progressive loss of religious values and the fact that suicide is considered to be an integral part of medical knowledge must be taken into consideration when assessing the risk of suicide. The sociological and psychoanalytical approaches attempt to help draw the suicidal subject out of the his/her personal implication by affecting the social and subconscious aspects of the problem respectively. Other elements such as psychiatric, sociocultural, biological and psychopathological factors are also involved in evaluating the risk of suicide.Risk FactorsDurkheim's analysis of the social, familial and occupational factors observed in suicide remains pertinent for assessing risk. Psychiatric disorders are also highly significant risk factors since some type of disorder is found in approximately 90% of all suicide victims. Affective disorders including rapidly alternating bipolar behavior, psychoses, particularly schizophrenia, and borderline personality are the most frequently observed, especially when associated with certain types of behavior such as drug or alcohol abuse. The risk related to other factors such as suicidal behavior (attempts or ideation) is independent of the psychiatric illness. For example, the risk of successful suicide is 30 greater the year after an attempted suicide than in the normal population.Assessing RiskThere are no known clinical means, notably psychometric, which can successfully predict the imminence of suicide. Recent studies on brain monoamine levels have shown that a lower 5-HIAA level does play some role in suicidal behavior, particularly violent suicide, although there is no predictive power for normality. It is important to recall that certain advances in the field of psychopathic illnesses offer new insight into concepts such as the death instinct and the suicidal act itself.

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