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Attempted suicide and suicide are prevalent in individuals with bipolar disorder (BD). Extant evidence indicates that history of suicide attempts, percentage of time spent in a depressed state, and hostility are factors associated with suicide attempts and completed suicide. Childhood adversity (eg, sexual and physical abuse) is emerging as a risk factor for suicide attempts in adults with BD. The pertinacity of medical comorbidity (eg, obesity, metabolic syndrome) in the bipolar population is further underscored by its preliminary association with suicidality. Biomarkers such as cerebrospinal fluid monoamine metabolite levels may be predictive of suicide attempts and lethality in BD. Compelling evidence supports an antisuicide effect of long-term lithium prophylaxis; lithium's salutary effect is mediated primarily by reduced lethality of suicidal acts. Conventional unimodal antidepressants may engender or exacerbate suicidality in susceptible individuals with BD. A nascent database suggests that adjunctive psychosocial interventions may further reduce suicide risk in bipolar individuals.

Generally, people with learning disabilities now live in community settings and use generic health services. Those who develop behavioural or psychiatric disturbances may be taken to a hospital accident and emergency (A&E) department. An A&E visit can be the starting point of a comprehensive assessment of these disturbances. This article provides a framework for the initial assessment, management and disposition of patients with learning disabilities and behavioural disturbance presenting to an A&E department.

Although limited by small sample size and potential recall biases, this study suggests that positive clerkship experiences and participation in psychiatry electives may be modifiable programmatic factors that could enhance recruitment to psychiatry.

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