Prevention Tips for Clinicians

Medscape: Assessing Suicide Risk - 12 things that should alert a clinician to a real suicide potential:

 1. Patients with definite plans to kill themselves – People who think or talk about suicide are at risk; however, a patient who has a plan(e.g., to get a gun and buy bullet) has made a clear statement regarding risk of suicide.

 2. Patients who have pursued a systematic pattern of behavior in which they engage in activities that indicate they are leaving life – This includes saying goodbye to friends, making a will, writing a suicide note, and developing a funeral plan.

 3. Patients with a strong family history of suicide – Family history of suicide especially indicative of suicide risk if the patient is approaching the anniversary of such a death or the age at which a relative committed suicide.

 4. The presence of a gun, especially a handgun.

 5. Being under the influence of alcohol or other mind-altering drugs – Drug abuse is especially significant if the drugs are depressants.

 6. If the patient encounters a severe, immediate, unexpected loss – E.g., when a person is fired suddenly or left by a spouse.

 7. If the patient is isolated and alone.

 8. If the person has a depression of any type.

 9. If the patient experiences command hallucination – A command hallucination ordering suicide can be a powerful message of action leading to death.

 10. Discharge from a psychiatric hospital – Patients are at suicide risk upon discharge from a psychiatric hospital, which is a very difficult time of transition and stress; the structure, support, and safety of the institution are no longer available to the patient; the patient feels apprehension and is confronted with the reality of change, which translates into fright and vulnerability.

 11. Anxiety – Anxiety in all of its forms leads to a risk for suicide; the constant sense of dread and tension proves unbearable for some.

 12. Clinician’s feelings- Regardless of what the patient says or does, it matters if the clinician has a feeling that the patient is going to commit suicide; such perceptions are part of the clinical judgment and are an important part of the suicide assessment and intervention.

Author: Stephen Soreff, MD, President of Education Initiative, Nottingham, NH; Faculty, Boston University, Boston , MA and Daniel Webster College, Nashua, NH

 

Chief Editor: Eduardo Dunayevich, MD, Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati College of Medicine; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

 

Retrieved from Medscape Mobile App: Suicide

 

There are a variety of suicide risk assessment tools that practitioners can use.  The following is one to assess suicide risk.  The practitioner should obtain information from the patient self-report and clinical interview as well as additional collaborative sources. 

 

Dr. Rudd calls this: THE SUICIDAL MODE - risk factors contributing  to SUICIDALITY  (PTPTBE) : Predispositions. Triggers. Physiology. Thoughts. Behaviors. Emotions:

 

PREDISPOSITIONS (Causes):

  1. Genetic factors.

  2. Medical illness.

  3. Family Suicide history.

  4. Trauma history.

  5. Impulsivity.

  6. Aggression.

  7. Previous Suicidal behaviors.

  8. Psychiatric history.

 

TRIGGERS: (Perceived loss):

  1. Job.

  2. Relationship.

  3. Financial.

  4. Illness.

  5. Legal.

  6. Traumatic events.

  7. Significant other.

  8. Major life changes.

 

PHYSIOLOGY:

  1. Agitation.

  2. Sleep disturbance.

  3. Concentration problems.

  4. Physical pain.

 

BEHAVIORS:

  1. Substance abuse.

  2. Self-harm.

  3. Preparing for death.

  4. Practicing and Rehearsing Suicide.

  5. Suicide threats.

  6. Poor expression of emotion.

  7. Social withdrawal.

 

EMOTIONS:

  1. Shame.

  2. Guilt.

  3. Anger.

  4. Anxiety.

  5. Panic.

  6. Depression.

Brief Cognitive Behavioral Therapy (B-CBT) For Suicidal Soldiers, Treatment Manual

M. David Rudd, Ph.D., ABPP,  University of Utah

Craig J. Bryan, PsyD, ABPP, University of Texan Health Science Center at San Antonio