Suicide and Homelessness

Suicide behaviour rates vary significantly between countries due to a range of cultural, behavioural and health-related factors. Gender and age-related factors also appear to be impor tant key determinants of vulnerability to suicide ideation and suicide completion. The homeless population is particularly at risk, due to multiple complex issues that relate to social exclusion, alcohol, drug, mental health and nutritional issues. Studying homeless people is problematic due to access, the transitory nature of their contact with statutary services, problems of self-repor t and recall in people - some of whom have mental health and cognitive issues. There is an increasing interest from practitioners and academic researchers in spiritual factors that appear to modulate the responses of an individual to the internal and external threats that underlie the motivation to end his or her life. Effective approaches to suicide prevention and crisis management require a good understanding of the interplay between this complex set of biological, psychological and social domains. These will be explored in the final section of this review. This paper, therefore, aims to provide a non-systematic review of the existing literature published in academic journals and relvant ‘grey literature’ and focuses on themes in the literature that will hopefully inform both policy and practice

Novos sedativos hipnóticos The newer sedative-hypnotics

Nas últimas décadas houve um esforço para o desenvolvimento de hipnóticos mais seguros e eficazes. Zolpidem, zaleplona, zopiclona, eszopiclona (drogas-z) e indiplona são moduladores do receptor GABA-A, os quais agem de forma seletiva na subunidade &#945;1, exibindo, desta forma, mecanismos similares de ação, embora evidências recentes sugiram que a eszopiclona não seja tão seletiva para a subunidade &#945;1 quanto o zolpidem. Ramelteon e tasimelteon são novos agentes crono-hipnóticos seletivos para os receptores de melatonina MT1 e MT2. Por outro lado, nos últimos anos, o consumo de drogas antidepressivas sedativas tem aumentado significativamente no tratamento da insônia. Como droga experimental, a eplivanserina tem sido testada como um potente agonista inverso do subtipo 5-HT2A da serotonina, com um uso potencial na dificuldade da manutenção do sono. Outro agente farmacológico para o tratamento da insônia é o almorexant, o qual apresenta um novo mecanismo de ação envolvendo antagonismo do sistema hipocretinérgico, desta forma levando à indução do sono. Finalmente, também discutiremos o potencial papel de outras drogas gabaérgicas no tratamento da insônia.<br>There has been a search for more effective and safe hypnotic drugs in the last decades. Zolpidem, zaleplon, zopiclone, eszopiclone (the z-drugs) and indiplon are GABA-A modulators which bind selectively &#945;1 subunits, thus, exhibiting similar mechanisms of action, although recent evidence suggests that eszopiclone is not as selective for &#945;1 subunit as zolpidem is. Ramelteon and tasimelteon are new chrono-hypnotic agents, selective for melatonin MT1 and MT2 receptors. On the other hand, the consumption of sedative antidepressant drugs is significantly increasing for the treatment of insomnia, in the last years. As an experimental drug, eplivanserin is being tested as a potent antagonist of serotonin 2-A receptors (ASTAR) with a potential use in sleep maintenance difficulty. Another recent pharmacological agent for insomnia is almorexant, which new mechanism of action involves antagonism of hypocretinergic system, thus inducing sleep. Finally we also discuss the potential role of other gabaergic drugs for insomnia