Maurizio Pompili

According to the World Health Organization (2016), mental disorders dramatically contribute to the social and financial burden across countries. Specifically, they negatively impact the quality of life among those affected and their families as well are a source of economic consequences around the world. Despite efforts spent for caring for psychiatric patients and treating mental disorders, there are still many unmet needs in several domains of mood disorders, schizophrenia, and suicide risk. For example, treatment resistance, nonadherence, and adverse effects are some of the more essential unmet needs. It has been repeatedly shown that the needs of patients, relatives, the community at large and those of the governmental bodies only partially overlap. For instance, patients and their families are more concerned about quality of life, treatment, autonomy, independent living and so on; governmental stakeholders are typically more concerned about relapse prevention and reduction of hospitalizations. Unmet Needs in Modern Psychiatry features contributions by opinion leaders in the treatment of psychiatric disorders. Reviews in this issue cover treatment options and perspectives for bipolar disorder, schizophrenia, cognitive symptoms in major depressive disorder, Leber's hereditary optic neuropathy and other rare CNS / neurodegenerative diseases. It represents a decisive step in the management of patients suffering from psychiatric illness with the goal of enabling healthcare professionals to identify the most common needs of those affected, describe the type of aid, and determine the associated variables to unmet psychiatric needs.

In the last 45 years suicide rates have increased by 60% worldwide. Suicide is now among the three leading causes of death among those aged 15-44 years (both sexes); these figures do not include suicide attempts up to 20 times more frequent than completed suicide. Suicide worldwide was estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former socialist economies in 2020. The economic costs associated with completed and attempted suicide are estimated to be in the billions of dollars. One million lives lost each year are more than those lost from wars and murder annually in the world. The book summarizes relevant data on suicide in countries belonging to different cultures and geographical areas. Specifically, the book discuses the relationship between suicide prevention agencies including government organizations; what the important issues are and what can be learned from different contests. Readers will learn how the many factors underlining suicide risk come into play in the determination and precipitation of risk. Cultural aspects are highlighted to provide explanation for the different scenarios regarding suicide.

Most cases of suicide (81%-95%) in the general population involve psychiatric illnesses, nearly half of which (48.5%) are mood disorders. Internationally, the overall average suicide rate has been rising gradually over the past half-century, with increases reported in about half of nations, mainly among men, and moderate decreases found in another half, including in Northern Europe and North America. This book reviews whether the use of antidepressants is associated with benefits in terms of completed or attempted suicide, whether the increasing use of SSRIs is associated with benefits in terms of decreased rates of suicide with the aim of generating evidence-based suggestions for clinicians.

Cigarette smoking is associated with an increased risk for suicide. However, findings regarding this relationship are not yet consistent. Despite the fact that the prevalence of smoking is higher in suicidal individuals, it is not clear that smoking itself (or the effect of nicotine on brain function) is directly involved in suicidality or whether other factors associated with both suicide and smoking are implicated in this relationship. Indeed it has been found that several suicide risk factors are more common among current smokers than among those who have never smoked. This book examines the findings in regards to the increased risk in suicide among cigarette smokers.

The main purpose of this book is to provide the first comprehensive analysis of suicide in psychiatric patients. 95% of those who commit suicide had a psychiatric disorder and yet suicide is rarely investigated in psychiatric patients. The book provides a relevant contribution to the prediction and prevention of suicide. This is a first book devoted to the subject with comprehensive chapters, including epidemiology, risk factors, preventive strategies and available treatments.

Why an entire volume on suicide in schizophrenia? It would appear that international literature already provides enough information in this field. Also, the daily growing number of papers on suicide among schizophrenic are certainly a more updated source of information may contribute to the reduction of deaths by suicide among these patients. Yet, as in the case of suicide as a whole, this progress of knowledge does not match with reduction of suicide rates, let alone reduction of suicide rates among people with schizophrenia. Maybe a summary, an overview that cannot be achieved with a simple Medline search may help those who are involved and those who should be involved in the prevention of self-killing of schizophrenic patients. This book, therefore, reports essays of some of the opinion leaders in the field with the aim to shed light to such overwhelming phenomenon.