Makindo Medical Notes

Related Subjects: |Psychiatric Emergencies |Depression |Mania |Schizophrenia |Suicide |Acute Psychosis |Delusions |General Anxiety Disorder |Obsessive-Compulsive disorder |Wernicke Korsakoff Syndrome |Medically Unexplained symptoms |Postpartum/Postnatal Depression |Postpartum / Postnatal Psychosis |Eating disorders in Children

In hospital, all overdose patients should receive a psychiatric evaluation. In primary care, patients with depression or other mental health issues should be assessed for self-harm risk. Familiarize yourself with local policies, but any patient who attempts suicide should ideally undergo psychiatric evaluation before discharge.

Initial Assessment of Suicide Risk

• Direct Inquiry: Ask about suicidal thoughts, plans, and intentions directly and sensitively. Example: “Have you had thoughts about harming yourself?”
• Plans and Means: If thoughts are present, inquire about any specific plan and access to means (e.g., medications, weapons).
• Risk Severity: Evaluate for:
  • Presence of a specific plan
  • Access to lethal means
  • History of previous suicide attempts
  • Mental health conditions (e.g., depression, psychosis)
  • Lack of social support
• Silent Risk: Those with strong intent to end their lives may not disclose their plans. Close monitoring and professional guidance are essential.

Suicide Risk and Mental Health

Key Risk Factors for Suicide

• Previous suicide attempts
• Mental health conditions (e.g., depression, personality disorders)
• Substance use disorders (alcohol or drug abuse)
• Chronic medical conditions (e.g., chronic pain)
• Significant life events (e.g., bereavement, job loss)
• Family history of suicide
• Social isolation or lack of support

Immediate Management of Suicide Risk

• Low Risk (No Active Ideation):
  • Provide emotional support and schedule follow-up appointments.
  • Consider counseling or therapy (e.g., cognitive-behavioral therapy).
• Moderate Risk (Thoughts but No Plan):
  • Increase follow-up visits and establish a safety plan.
  • Involve family or close friends for additional support with consent.
  • Consider referral to mental health specialist or crisis intervention.
• High Risk (Active Ideation, Plan, or Means):
  • Immediate referral to emergency psychiatric services or hospitalization.
  • Remove access to lethal means if possible (e.g., medications, firearms).
  • Provide emergency treatment for any co-occurring psychiatric conditions.

Long-Term Management and Follow-Up

• Psychotherapy: Refer for evidence-based therapies like cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT), especially for chronic suicidal ideation.
• Medication: Antidepressants, mood stabilizers, or antipsychotics may be appropriate based on the underlying condition.
• Social Support: Encourage engagement with family, friends, and community resources.
• Regular Follow-Up: Schedule consistent follow-up appointments to assess the patient’s progress, monitor treatment, and review safety plans.

Specialist Referral and Psychiatric Involvement

• Refer to a psychiatrist for a comprehensive evaluation if the patient presents high risk or complex psychiatric conditions.
• Engage crisis intervention teams or community mental health services for immediate but non-hospital interventions.
• Consider inpatient psychiatric admission for persistent high-risk patients despite outpatient interventions.

Documentation

Ensure thorough documentation of risk assessments, safety plans, and management decisions, including discussions with the patient and family.