Transcript Suicidal Patients

Dr. Gamal Salah Mousa
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 Those patients should first be referred
to the appropriate medical or surgical
services for emergency treatment
 Call to assess a suicidal patient from
medical, surgical or emergency room if: •-Recently has attempted suicide
after being stable and medically
clear.
•-With suicidal ideation.
Dr. Gamal Salah Mousa
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•Discover the underlying diagnosis
•Take steeps necessary to ensure
the safety of the patient
•Initiate appropriate treatment
Dr. Gamal Salah Mousa
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Major depressive disorder
Depressive disorder NOS
Adjustment disorder
Dysthymia
Cyclothymic disorder
Dr. Gamal Salah Mousa
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Bipolar I or II disorder
/depressive disorder
Mood disorder duo to general
medical condition
Schizophrenia
Schizoaffective disorder
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Alcohol or substance abuse
Anxiety disorders
Personality disorders
Malingering
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•The patient is threatening and
has a plan
•Age above 45 years
•Male : sex
•Violent behaviour
•Previous suicidal attempts
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•Alcohol dependent
•Previous psychiatric admission
•Family history of suicide
•Medical illness
•Social isolation
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1 – Chart review
•Cause of admission
•Medical problems
•Medication
•Psychiatric history
•Substance abuse
•History of suicidal ideation or attempts
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2 –Vital signs and airway
•fever
•Signs of airway obstruction
•Signs of withdrawal (autonomic
instability )
•Signs of intoxication
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3 – Quick look test
•look for the patient: sad, depressed,
angry, confused, manipulative or
demanding
•psychomotor agitation or retardation
•withdrawn, isolated or communicating
with others
•presence of psychotic symptoms
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Identify your self and cause of your
coming
Basic information about the patient
What has been happening? If the
patient is reluctant to talk, it may be
more effective to talk about general
history first and try to develop rapport
with the patient. If the patient is
disorganized or psychotic, structured
interview is indicated
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Encourage the patient to discus the
plan if present
Not to put words into the patient
mouth
Remember that you cannot plant
thoughts in the patient “s head
If there are pauses in the interview, try
to wait.
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1 - Recent history
(Major depression,
dysthymia)
adjustment
disorder,
or
What has been happening?
Any recent stresses
Patient’s feeling (sad, blue, or down in the
dumps)
Any changes in sleep or appetite
Anything the patient enjoy doing
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2 - Suicidal ideation:
(Elicit positive feelings from the patient,
e.g. religious and children)
Suicidal thoughts (what, how long
and when)
Is there a wish to be dead?
Is there a sense of hopelessness,
guilt or self-recrimination?
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2 - Suicidal ideation ( cont.) :
Details of the plan if present
Does he have the means and
intention to carry out the plan?
What would happen after his
death?
What prevents the patient from
actually attempting suicide?
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3 - Substance abuse:
•Alcohol, opiate, cocaine or benzodiazepine
•How much/day – how long- when last dose
4 -Medical history:
•Full medical history
•Current medical status and medication
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5 - History of suicide attempts or
gestures:
•Much
details
as
possible
(discovering the trial, treatment,
regret not having succeeded)
•Planned or impulsive
•Was it manipulative?
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6 - Past psychiatric history:
•Previous hospitalization and
treatment
•History of depressive episode
•History of mania
•History of psychosis
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7 - Family and social history:
(Seriousness of the attempt)
•Psychiatric illness
•Suicide
•Patient’s
interpersonal
relationship
•Work history
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•Appearance
•Behaviour
•Psychomotor level of activity
•Speech (slow / pressured)
•Affect
•Psychotic manifestation
•Insight and judgment
•Level of impulsiveness
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•No matter what the underlying
diagnosis is, the safety of the patient
is paramount.
•Admit the patient if he is a substantial
risk
to
himself
(voluntary
or
involuntary)
•If admission is not indicated, a prompt
referral to out patient clinic should be
made.
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•If the patient is impulsive or has an
active plan, it may be necessary to
transfer him to a psychiatric unit or
initiate a one- to- one observation.
•The treatment and management start
during the interview, a supportive style,
with emphasis on encouraging the
patient to discuss concerns, can be
very therapeutic.
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•If the patient is already hospitalized
and has passive suicidal ideation
and would approach the staff if not
feeling well, it would be reasonable
to refer the patient to the
psychiatric liaison service to follow
up in the morning
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•Routine tests should include a CBC,
electrolytes, liver function test, thyroid
function tests, a VDRL for syphilis, and an
ECG, check a urine toxicology screen.
•If depression duo to medical condition,
notify the internist to discuss further
management.
•If there are psychotic symptoms, you may
want to start a neuroleptic.
.
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•If the suicidal ideation is secondary to
substance abuse or withdrawal from a
substance, observation for signs of
withdrawal. Caution in using anxiolytic
or hypnotic medication in a patient
with substance abuse.
I•f the suicidal ideation is related to a
personality disorder, assess the
need for one- to –one observation
and set limits with the patient as to
what can beDr. Gamal
done
immediately
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The patient may require medication for
insomnia, temporary use of an anxiolytic
In general you do not need to start
antidepressant medication immediately
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Overdose
Suicide
Parasuicide
Other Diagnosis
51 Patients ( Total
161 Patients)
16 Patients (15
Inpatient Trans.)
20 Patients ( 13 No
TTT + 7 OPD
trans.)
15 Patients
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