Parasuicide. A review of treatment interventions.

From review of studies of treatment intervention in parasuicide it is concluded that: (1) Suicide prevention centres do not lower the incidence of suicide. (2) Retrospective follow-up studies of patients self-selected for treatment or no treatment find that patients who attend for treatment have a lower repeat rate of parasuicide. This may have nothing to do with treatment. (3) Intensive domicillary follow-up for 3-6 months after inpatient treatment in a specialised unit for parasuicide is no better at preventing further parasuicides than conventional follow-up in outpatient department or via the GP. (4) A multidisciplinary outreach programme was effective in one study but not three others. (5) Behaviour therapy was no better than insight oriented psychotherapies when administered intensely over 10 days for inpatients with a previous history of overdose. (6) Medication in the form of depot flupenthixol, 20 mg every 4 weeks was significantly better than placebo for chronic repeaters (3 or more attempts) but Mianserin 30 mg/d was not. (7) There was no relationship between improved symptoms, improved social circumstances or the repeat rate for parasuicide. In a controlled trial conducted by the authors in parasuicides, Mianserin 60 mg/d reduced depressive symptoms significantly more rapidly than Nomifensine or placebo but there was no difference by 6 weeks and the risk of repeat was not affected.