Treating impulsivity and anxiety in the suicidal patient.

It has been found that while over 90% of people who commit suicide have a psychiatric illness at the time, over 50% are under active psychiatric or mental health care. How can suicide risk be detected and preventive treatment provided? Both communication of suicidal ideation or intent and prior suicide attempts have been shown to be risk factors, which should be assessed in patients with psychiatric illness. Research shows that suicidal ideation is often not communicated to professionals or is denied by patients just prior to suicide and, when present, is often useful not as an immediate risk factor, but as a chronic risk factor. Suicide attempts predict a 10-30% occurrence of suicide over 10 years, but often do not indicate immediate risk. Recent research has shown that impulsiveness and severe anxiety, panic attacks, and agitation comorbid with depression are often immediate suicide risk factors that are potentially modifiable if recognized and treated urgently with effective medications and watchful support.