Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary.
Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
Pharmacol Ther. 2023 Apr;244:108390. doi: 10.1016/j.pharmthera.2023.108390. Epub 2023 Mar 20.
The impact of suicide on our societies, mental healthcare, and public health is beyond questionable. Every year approximately 700 000 lives are lost due to suicide around the world (WHO, 2021); more people die by suicide than by homicide and war. Although suicide is a key issue and reducing suicide mortality is a global imperative, suicide is a highly complex biopsychosocial phenomenon, and in spite of several suicidal models developed in recent years and a high number of suicide risk factors identified, we still have neither a sufficient understanding of underpinnings of suicide nor adequate management strategies to reduce its prevalence. The present paper first overviews the background of suicidal behavior including its epidemiology, age and gender correlations, and its association with neuropsychiatric disorders as well as its clinical assessment. Then we give an overview of the etiological background, including its biopsychosocial contexts, genetics and neurobiology. Based on the above, we then provide a critical overview of the currently available intervention options to manage and reduce risk of suicide, including psychotherapeutic modalities, traditional medication classes also providing an up-to-date overview on the antisuicidal effects of lithium, as well as novel molecules such as esketamine and emerging medications and further molecules in development. Finally we give a critical overview on our current knowledge on using neuromodulatory and biological therapies, such as ECT, rTMS, tDCS, and other options.
自杀对我们的社会、精神卫生和公共卫生的影响是毋庸置疑的。每年全球约有 70 万人因自杀而死亡（世界卫生组织，2021 年）；自杀导致的死亡人数多于他杀和战争。尽管自杀是一个关键问题，降低自杀死亡率是全球当务之急，但自杀是一个高度复杂的生物心理社会现象，尽管近年来已经开发了几种自杀模型，并且已经确定了大量的自杀风险因素，但我们仍然没有足够的了解自杀的根本原因，也没有足够的管理策略来降低其流行率。本文首先概述了自杀行为的背景，包括其流行病学、年龄和性别相关性，以及与神经精神障碍的关联及其临床评估。然后我们概述了病因背景，包括其生物心理社会背景、遗传学和神经生物学。在此基础上，我们对目前可用的管理和降低自杀风险的干预措施进行了批判性的概述，包括心理治疗模式、传统药物类别，还提供了锂的抗自杀作用的最新概述，以及新型分子，如 Esketamine 和新兴药物和正在开发中的其他分子。最后，我们对我们目前在使用神经调节和生物治疗方面的知识进行了批判性的概述，如 ECT、rTMS、tDCS 等。
