1. SUICIDE: RISK FACTORS Dr. Nooshin Parvaresh Child & Adolescent Psychiatrist Kerman University Of Medical Sciences

2. SUICIDE Involves continiuum from non-suicidal behavior to suicidal ideas, suicide attempts and suicide Consider self-injurious acts as potentially suicidal in youths (reversibility, fluctuating and not for themselves believes, impaired lathality estimation) more sever self-harm and later suicide with self-harm behavior

3. PRIMARY PSYCHIATRIC DISORDERS Psychological autopsy : 90% psychiatry disorder 32-54% major depressive disorder 1/5 bipolar disorders comorbidity substance abuse Non-fatal suicidal behavior : same psychiatric disorders substance abuse sexual orientation in male Evaluate suicidal risk during all evaluations

4. D EVELOPMENTAL AND PERSONALITY DISORDERS Borderline, antisocial, narcissistic, schizoid traits Chronic aggression Impulsivity Odd thinking Mood instability Poor interpersonal relationship Neuroticism Identify traits that suggest future personality disorder

5. N EUROBIOLOGICAL RISK FACTORS Serotonin dysregulation Growth hormone secretion HPA axis dysregulation Gene environmental interaction May point toward new treatment options

6. E NVIRONMENTAL STRESS RISK FACTORS Family loss Parental psychiatric disorder and substance abuse Family suicidal behavior by transmission of impulsive aggression Exposure to violence and assaultive behavior

7. E NVIRONMENTAL STRESS RISK FACTORS Physical abuse, mediated by stressors and mental health problems Sexual abuse, risk rises with severity and transmits to subsequent generations Emotional neglect as predictor of self harm Exposure to suicide

8. E NVIRONMENTAL STRESS RISK FACTORS Early physical stress Chronic medical illness Functional impairment School drop out Economic strain

9. S OCIAL MALADJUSTMENT RISK FACTORS Impaired interpersonal relations Low self esteem Sense of incompetence Social support (inability to communicate openly) Predictability of environment (inadequacies in mobilizing support)

10. O THER RISK FACTORS FOR SUICIDE Previous self harm or suicidal attempt Quality of childhood attachment Poor problem solving skill Ego mechanisms: -denial of affects and events -reaction formation, exaggeration of skills

11. O THER RISK FACTORS FOR SUICIDE Availability of lethal agents (impulsive acts) Cultural factors Same sex orientation,mediated by family rejection and abuse

12. O THER RISK FACTORS FOR SUICIDE Bulling by peers -higher frequency -family adversity -presence of maltreatment -family history of suicidal behaviors -symptoms of depression, psyhosis, and conduct -borderline personality traits

13. O THER RISK FACTORS FOR SUICIDE Medications warning for all classes antidepressant - for depressed youth - increase clinical monitoring Use medications specific to diagnosis - caution for disinhibition Restriction the availability of acetaminophen in some countries