[Evaluation of the risk of suicide]

Before committing a suicidal act, many people consult a doctor because of somatic or functional complaints. Most of them do not express their suicidal thoughts, unless they are asked direct questions. The taking of a thorough history, possibly supplemented by information from relatives or friends, is the safest basis for an optimal assessment of the suicide risk. Predisposing factors are: 1. Depression 2. Alcohol or drug dependence 3. Old age and loneliness 4. Warnings or threats of suicide 5. Past suicide attempts The presuicidal syndrome, as described by Ringel, consists of the narrowing of mental functions, the turning of suppressed aggression against oneself and suicide phantasies. The concept of the suicidal syndrome, as well as the new concepts of narcissism give important insights into the dynamics of suicide. A verbal promise should be obtained from suicidal patients that they will not commit a suicidal act for a specific period of time, e.g. until the next consultation with the doctor or until a critical point in the near future has been overcome. In any case, a trustful doctor-patient-relationship plays an essential part in suicide prevention.