Table 3.

Comparison of the newly described suicide-specific syndromes [acute suicidal affective disturbance (ASAD) and suicidal crisis syndrome (SCS)] with suicidal behavior disorder (SBD) included in DSM-5 and with the classical suicidal crisis concept.

	Suicide-specific syndromes		DSM-5 category	Classical crisis concept
	ASAD	SCS	SBD	PSS
Term	Acute Suicidal Affective Disturbance	Suicidal Crisis Syndrome	Suicidal Behavior Disorder	Pre-Suicidal Syndrome (Suicidal Crisis)
References	Tucker et al. (17)	Galynker (18)	DSM-5 (11)	Ringel (21) and Caplan (22)
Key-symptom	- Drastic increase in suicidal intent over the course of hours or days	- Persistent or recurring feeling of entrapment	- Suicide attempt within the last 24 months	- Ringel-triad:    - Constriction    - Inhibited aggression turned toward the self    - Suicidal fantasies
Other major characteristics	- Social and self-alienation - Hopelessness - Hyperarousal	- Affective and cognitive dysregulation with behavioral symptoms:    - Affective disturbance    - Loss of cognitive control    - Disturbance in arousal    - Social withdrawal	- Not applied:    - To suicidal ideation or preparatory acts    - If initiated during delirium or confusion    - If undertaken solely for political or religious objective	- Caplan's crisis concept:    - Perceive an event as being threatening    - Unable to modify or lessen the impact    - Increased fear, tension, confusion    - High level of discomfort    - State of disequilibrium - Other symptoms:    - Regression    - Autonomic symptoms    - Insomnia    - Psychomotor symptoms    - Behavior changes
Course, dynamics	- Rapid (up to hours or days) - Spike-like (brief and intense) - Time-limited	- Persistent or recurring	- Planned (chronic) or impulsive (acute) - 24 months	- Fluctuating - Vortical