Suicide risk assessment

Because of the complexity and involvanent of suicide risk assessment, trained mental health professionals should lead this type of assessment. Contacting parents and connecting with mental health resources are uecessary components of suicide risk assessmeut. Furthermore, suicide risk assessment is ongoing (Granello, 2010). Therefore, follow-up is necessary from trained mental health professionals for students that are a suicide risk. 

Granello, D. H. (2010). The process of suicide risk assessment Twelve core principles. Journal of Counseling and Development, 88, 363-371. 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

Assessment of suicidal risk is an inherent component of every psychiatric evaluation and should be conducted during the initial visit or... 

Posner K., Oquendo M., Gould M., Stanley B., Davies M., Columbia classification algorithm of suicide assessment (C-CASA) Classification of suicidal events in the FDA s pediatric suicidal risk analysis of antidepressants. The American Journal of Psychiatry, 2007 164 1035-1043. 

Muller, RY, Dambach, D., Gemzik, B., Hartmann, A., Ratchffe, S., Trendelenburg, C., Urban, L. (2015). Integrated risk assessment of suicidal ideation and behavior in drug development. Drug Discovery Today, 20, 1135-1142. 

The assessment should cover the proposed normal use of the product and treated material if applicable. In addition, the realistic worst-case scenarios should include reasonably foreseeable misuse, such as ingestion by a child, but not accidents or attempted suicides). It should also include relevant production and disposal issues for both the product and treated material. Therefore, the risk assessment should cover the entire the lifecycle of the product. 

Spiritual beliefs and thoughts about suicide may be deeply entwined and should be considered during risk assessments... 

Poor anxiety containment Passes anxiety onto you, e.g. hints mysteriously at suicide, but won t elaborate Feel anxious over-react to manage own anxiety, e.g. detain Acknowledge anxiety Discuss with senior/team Make decisions based on calm risk assessment, rather than anxiety. Explain that this may take time, so Karen doesn t interpret this as procrastinating/being... 

Explore the attenpted hanging and assess suicide risk (Ch.51)... 

General psychiatric admission Only if low medical risk (and no need for NG feeding) Psychiatric comorbidity High suicide risk Intolerable social circumstances prevent safe community management NB occasionally appropriate to admit for safety whilst awaiting specialist assessment... 

Assess for the safety of others and potential for violence. If accompanied by friends or family with whom the patient is living, ask them to remove from the home all guns, caustic chemicals, medications, and objects the person might use to harm self or others. Risk factors for suicide include severity of depression, feelings of hopelessness, comorbid personality disorder, and a history of a previous suicide attempt.19... 

Because of the risk of suicide, patients should be carefully assessed for suicidal ideation and risk from the beginning of treatment. Most suicide attempts occur within 2 months of beginning of treatment. This justifies the use of drags that carry a low risk in overdose, since most patients attempt suicide with their own medication in patients who are already suicidal. But some of these same drags may lead to the emergence of agitation and suici-dality in patients who at baseline appeared well. 

Major depression is a significant risk factor for suicide. The presence of suicidal ideation should be assessed initially and repeatedly over the course of treatment. In this respect, depressive disorders are a major health care problem, contributing to 70% of suicide-related deaths (with a 15% mortality risk associated with suicide in untreated recurrent major episodes). 

Generally, the clinical and the psychosocial factors that combine to increase the risk of suicide have a high sensitivity but a low specificity. Because only a small minority who meet these criteria successfully complete suicide, the clinician s task of accurately assessing risks is exceedingly difficult. 

As regular psychiatric assessment is not always possible, the identification of easily detectable predictive factors of severe psychiatric disorders may help select which patients should undergo close psychiatric assessment. In 71 patients treated with interferon alfa alone or combined with ribavirin for chronic hepatitis C, female sex, scores on the MADRS at 4 months of treatment, sleep disorders, and prior antidepressant use were independent risk factors of suicidal behavior or depression (349). This study also suggested that prolonged follow-up is required, as 8% of patients still had suicidal behavior 6 months after the end of treatment. 

Otto DA, Soliman S, Svendsgaard D, et al Neurobehavioral assessment of workers exposed to organophosphorus pesticides, in Advances in Neurobehavioral Toxicol-ogy Applications in Environmental and Occupational Health. Edited by Johnson BL. Chelsea, MI, Lewis Publishers, 1990, pp 305-322 Parron T, Hernandez AF, Pla A, et al Clinical and biochemical changes in greenhouse sprayers chronically exposed to pesticides. Hum Exp Toxicol 15 957-963,1996a Parron T, Hernandez AF, Villanueva E Increased risk of suicide with exposure to pesticides in an intensive agricultural area a 12-year retrospective study. Forensic Sci Int 79 53-63,1996b... 

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