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== Overview ==
== Overview ==
Effective medical management include hospitalization of high risk individuals and stabilizing.
== Management ==
Medical management of patients who underwent suicide attempt or at high risk to commit suicide include:<ref name="pmid27354459">{{cite journal |vauthors=Shain B |title=Suicide and Suicide Attempts in Adolescents |journal=Pediatrics |volume=138 |issue=1 |pages= |date=July 2016 |pmid=27354459 |doi=10.1542/peds.2016-1420 |url=}}</ref><ref name="pmid27550977">{{cite journal |vauthors=Chun TH, Mace SE, Katz ER |title=Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies |journal=Pediatrics |volume=138 |issue=3 |pages= |date=September 2016 |pmid=27550977 |doi=10.1542/peds.2016-1570 |url=}}</ref>
* Hospitalization
* Stabilization


==Medical Therapy==
==== Hospitalization ====
Management includes identification of people who are at high risk of attempting to commit suicide and implementing behavioral and other psychiatric evaluation.  
All patients who attempted or at risk of suicide are admitted into hospital irrespective of their consent. As described identification of risk factors and presence of warning signs warrants an hospitalization.
* Identification of the triggers which cannot predict but help in getting aware of the individual
* Patients must be isolated and kept in room with minimal potential of harming himself.
** Mental disorders, particularly mood disorders, schizophrenia, anxiety disorders, and certain personality disorders
* Family members are allowed to stay if the patient intends.
** Alcohol and other substance use disorders
* A hospital staff must be assigned to provide constant observation.
** Hopelessness
* Transfer of the patient should take place by ambulance, and the paramedics must be aware of the suicide risk.
** Impulsive and/or aggressive tendencies
* Inpatient treatment should continue until the patient’s safety has stabilized.
** History of trauma or abuse
* Patients who are admitted involuntarily cannot be given medications other than that are required for stabilization.
** Major physical illnesses
* In case patients who are not  stable to consent and require medications for underlying psychiatric disorders, clinicians will need to petition a court to order treatment.
** Previous suicide attempt(s)
** Family history of suicide
** Job or financial loss
** Loss of relationship(s)
** Easy access to lethal means
** Local clusters of suicide
** Lack of social support and sense of isolation
** Stigma associated with asking for help
** Lack of healthcare, especially mental health and substance abuse treatment
** Cultural and religious beliefs, such as the belief that suicide is a noble resolution of a personal dilemma
** Exposure to others who have died by suicide (in real life or via the media and Internet)


* The next step is to admit all the patients who are at high risk for committing suicide
==== Outpatient Management ====
** Medical professionals advise that people who have expressed plans to kill themselves be encouraged to seek medical attention immediately.
* Indicated in patients who are stable and not at high risk of suicide attempt and includes:
** This is especially relevant if the means (weapons, drugs, or other methods) are available, or if the patient has crafted a detailed plan for executing the suicide.
** Involvement of the family to regularly monitor the patient
** [[Mental health professionals]] suggest that people who know a person whom they suspect to be suicidal can assist him or her by asking directly if the person has contemplated committing suicide and made specific arrangements, has set a date, etc.
** Restricting access to all lethal means of suicide
** Posing such a question ''does not'' render a previously non-suicidal person suicidal.
** Identifying and avoiding triggers for relapse of suicidal ideation and warning signs
** According to this advice, the person questioning should seek to be understanding and sympathetic above all else since a suicidal person will often already feel ashamed or guilty about contemplating suicide so care should be taken not to exacerbate that [[guilt]].
** Educating patients and caregivers
** Mental health professionals suggest that an affirmative response to these questions should motivate the immediate seeking of medical attention, either from that person's doctor, or, if unavailable, the [[emergency room]] of the nearest [[hospital]].
** Specifying coping strategies and healthy activities
** If the prior [[intervention]]s fail, mental health professionals suggest involving [[law enforcement]] officers. While the police do not always have the authority to stop the suicide attempt itself, in some countries including some jurisdictions in the US, killing oneself is illegal.
** Securing mental health follow-up within 48 hours.
** In most cases law enforcement does have the authority to have people involuntarily committed to [[mental health ward]]s. Usually a [[court order]] is required, but if an officer feels the person is in immediate danger he/she can order an involuntary commitment without waiting for a court order.
** Such commitments are for a limited period, such as 72 hours &ndash; which is intended to be enough time for a doctor to see the person and make an evaluation. After this initial period, a hearing is held in which a judge can decide to order the person released or can extend the treatment time.
** Afterwards, the court is kept informed of the person's condition and can release the person when they feel the time is right to do so. Legal punishment for suicide attempts is extremely.


===Mental health treatment===
==References ==
* Treatment, often including [[medication]], [[counseling]] and [[psychotherapy]], is directed at the underlying causes of suicidal thinking. 
* [[Clinical depression]] is the most common treatable cause, with [[alcohol abuse|alcohol]] or [[drug abuse]] being the next major categories.
* Other [[psychiatric disorder]]s associated with suicidal thinking include [[bipolar disorder]], [[schizophrenia]], [[Borderline personality disorder]], [[Gender identity disorder]] and [[eating disorders]]. 
* Suicidal thoughts provoked by crises will generally settle with time and [[Psychotherapy|counseling]]. Severe depression can continue throughout life even with treatment and repetitive suicide attempts or suicidal ideation can be the result.
* Methods for disrupting suicidal thinking include having family members or friends tell the person contemplating suicide about who else would be hurt by the loss, citing valuable and productive aspects of the patient's life, and provoking simple curiosity about the victim's own future.
* During the acute phase, the safety of the person is one of the prime factors considered by doctors, and this can lead to admission to a [[psychiatric ward]] or even [[involuntary commitment]].
* According to a [[2005]] [[randomized controlled trial]] by [[Gregory Brown]], [[Aaron Beck]] and others, [[cognitive therapy]] can reduce repeat suicide attempts by 50%.<ref name="Brown_et_al_2005">''[http://jama.ama-assn.org/cgi/content/abstract/294/5/563 Cognitive Therapy for the Prevention of Suicide Attempts]'', [[Gregory Brown|Brown, G.K.]], [[Thomas Have|Have, T.T.]], [[Gregg Henriques|Henriques, G.R.]], [[Sharon Xie|Xie, S.X.]], [[Judd Hollander|Hollander, J.E.]], [[Aaron Beck|Beck, A.T.]], [[Journal of the American Medical Association]], 2005</ref>
 
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}


[[Category:Primary care]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
[[Category:Needs overview]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 00:20, 30 July 2020

Suicide Microchapters

Home

Patient Information

Overview

Classification

Epidemiology and Demographics

Risk Factors

Screening

Physical Examination

Laboratory Findings

Psychiatric evaluation

Treatment

Medical Therapy

Psychotherapy

Pharmacotherapy

Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Effective medical management include hospitalization of high risk individuals and stabilizing.

Management

Medical management of patients who underwent suicide attempt or at high risk to commit suicide include:[1][2]

  • Hospitalization
  • Stabilization

Hospitalization

All patients who attempted or at risk of suicide are admitted into hospital irrespective of their consent. As described identification of risk factors and presence of warning signs warrants an hospitalization.

  • Patients must be isolated and kept in room with minimal potential of harming himself.
  • Family members are allowed to stay if the patient intends.
  • A hospital staff must be assigned to provide constant observation.
  • Transfer of the patient should take place by ambulance, and the paramedics must be aware of the suicide risk.
  • Inpatient treatment should continue until the patient’s safety has stabilized.
  • Patients who are admitted involuntarily cannot be given medications other than that are required for stabilization.
  • In case patients who are not stable to consent and require medications for underlying psychiatric disorders, clinicians will need to petition a court to order treatment.

Outpatient Management

  • Indicated in patients who are stable and not at high risk of suicide attempt and includes:
    • Involvement of the family to regularly monitor the patient
    • Restricting access to all lethal means of suicide
    • Identifying and avoiding triggers for relapse of suicidal ideation and warning signs
    • Educating patients and caregivers
    • Specifying coping strategies and healthy activities
    • Securing mental health follow-up within 48 hours.

References

  1. ↑ Shain B (July 2016). "Suicide and Suicide Attempts in Adolescents". Pediatrics. 138 (1). doi:10.1542/peds.2016-1420. PMID 27354459.
  2. ↑ Chun TH, Mace SE, Katz ER (September 2016). "Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies". Pediatrics. 138 (3). doi:10.1542/peds.2016-1570. PMID 27550977.

Template:WH Template:WS

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