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Questions to Ask Patients during assessment.
- about thoughts: currently have thoughts of killing yourself?
- about desire: currently have desire to kill yourself?
- about plan: currently have a specific plan to kill yourself?
Suicide Risk Assessment
- 1. questions of you ask
- 2. patient self-report questionnaires
- 3. assessing risk on an ongoing basis
Assessing Risk on an ongoing basis
suicide behavior, previous attempts, hx of psychiatric hospitalizations, family hx of suicide behavior, acute and chronic stressors, increased depression, mania, psychotic features, impulsivity, psychosocial factors (?), presence of deterrents, level of social support, psychological strength, reasons for dying/living
- 1. patients may be unwilling/unable to be accurate
- 2. allow sufficient time
- 3. obtain medical record
- 4. contact patients family/friends
- 5. contact other providers (past/current)
suicide nomenclature to avoid
- suicidal gestures
- suicidal manipulation
- failed suicide attempt OR successful suicide
- committed suicide
- self murder
- rational suicide
Typical Maladaptive Provider Reactions
- 1. labeling - "patient is resistant"
- 2. fortune telling - "he wont act on it, he just wants attention"
- 3. all-or-none thinking - "if he really wants to, i can't do anything to change his mind"
- 4. personalizing - "it's my fault he remains suicidal"
- 5. catastrophizing - "the patient is right and there is really no hope"
- 6. shoulds - "specialists should handle suicide patients"
- 7. over-generalizing - "all suicidal patients in the military are malingering"
Recommended Adaptive Provider Recommendations
- 1. be attentive - be calm, provide private, safe environment
- 2. do not express anger, exasperation or hostile passivity
- 3. be confident to be a stable source of support
- 4. stress a team approach, use "we" when discussing suicidal behavior
- 5. model hopefulness but make sure to acknowledge the patients distress and perspective on the problem
- 6. dont avoid the work suicide as the give the impresson that you stigmatize the concept
- 7. most importantly, dont immediately suggest hospitalization ... patients are most agreeable if one carefully explores various safety options and then plans for the most approproate clinical response to an acute suicidal episode