How to treat deliberate self-harm: From clinical research to effective treatment choice? Part 1: An update treatment efficacy among unselected patients referred to emergency room with deliberate self-harm

The therapeutic potential of reducing the risk of suicidal attempt repetitions has been widely studied in recent years, contributing to promote new techniques to reduce this risk. Yet still the question of indications and practical modalities of these techniques, as the subjects committing a suicide attempt are a heterogeneous population when considering their risk factors, diagnosis, and comorbidities. This work will aim to review randomized controlled trials, which have evaluated treatments for suicide attempt among suicidal patients, in that first part, and the sub-population at higher risk of patients with borderline personality disorder, in a second part. Several trials support the effectiveness of some interventions, ranging from simple (postcards, Green cards) to more structured ones. One of the main limitations seems to be the diversity of the population of suicidal patients. This review highlights the need to improve psychiatric assessment at the Emergency Department, targeting risk factors, and to develop specific care according to risk of repetition. (C) 2010 Elsevier Masson SAS. All rights reserved.