Insomniac symptoms and suicidality-link and management

Abstract

Alink between insomniac symptoms and suicidality has long been suspected and deserves specific attention. We examine the current evidence for this relationship from epidemiology and neurobiology in order to propose atargeted management. Clinical example and selective Medline-literature research for insomnia symptoms and suicidality. Epidemiological data and statistical analysis show that symptoms of insomnia are independent risk factors for suicidality. Neurobiological factors associated with combined insomnia symptoms and suicidality are: serotonergic dysfunction and circadian rhythm disorder leading to hypofrontality with reduced problem solving capacity and impaired emotional and impulse-control. Social isolation, recurrent rumination, comorbid psychiatric disorders, access to potentially lethal drugs or weapons need urgent evaluation in patients with acombination of suicidality and symptoms of insomnia. patients with insomnia and further risk factors for suicide need to be treated resolutely and at an early stage. Modern sleep-promoting antidepressants with low toxicity and antipsychotics must be preferred in the treatment of patients with insomniac sleep disorders and suicidality. Multimodal anti-insomnia and anti-depressive therapy adapted to the circadian rhythm can exert afavorable influence both on depressive-suicidal and insomnia symptoms and their inherent risks.