2. *
*First,many suicide attempts occur during an
acute crisis, such as a personal loss or the
exacerbation of an underlying psychiatric
disorder. This acute crisis is usually time
limited and may be resolvable or treatable.
*Second, suicidal patients are usually
ambivalent about dying and grateful for help.
3. *
*Suicide rates vary with age and are highest in
elders, particularly older white men Whites
and Native Americans have higher rates of
suicide than African Americans,Hispanics, or
Asians. Women attempt suicide three to four
times more often than men, whereas men are
three to four times more likely to die after an
attempt (due to use of more lethal methods)
and have higher suicide death rates in all age
groups
4. *
*A prior history of non-suicidal self-harm or
suicide attempt, even in the remote past, is an
important risk factor.
*affective disorder, especially major depression
*schizophrenia, bipolar disorder, borderline
personality traits or disorder, anxiety
disorder,and post-traumatic stress disorder.
*Both chronic and acute alcohol abuse are
associated with suicide.
*Chronic pain , Older age, Financial stress
8. *
*The etiology of suicide is a complex mix of
social, genetic, and psychological factors.
Current research suggests a biologic basis for
depression and suicide involving the
serotonergic systems.
11. *
*Suicide Precautions) No suicidal patient
should be allowed to leave before an
evaluation is completed.(
*Use of Restraints
*Pharmacologic Treatments) benzodiazepine
or short-acting antipsychotic, such as
haloperidol or olanzapine(
*Risk Assessment
12. *
*Patients feel more comfortable discussing
personal issues when health care personnel are
friendly, nonjudgmental, and supportive.
*When possible, consultation with an ethics
consultant or committee or legal
representation from the hospital can be
helpful, but in timesensitive conditions (eg,
respiratory depression) the physician should err
on the side of resuscitation.
17. *
*Documentation is important due to the variable
nature of suicide risk, the low rates of follow-
up with outpatient care, and the difficulty of
predicting imminent risk.
18. *
*Psychiatric Hospitalization) Hospitalization is not
proven to prevent future suicide and may even
precipitate adverse psychiatric consequences (eg,
increased feelings of hopelessness and
dependency).
*Discharge) Many patients who report suicidal
thoughts or have symptoms ofdepression can be
safely managed as outpatients if the risk of
subsequent suicide is judged to be acceptably
low.(
*Discharged patients should also be referred for
outpatient care, ideally within 72 hours because
suicide risk remains high shortly after discharge
from the ED.
