Inpatient Psychiatry Wiki

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====== Suicide Evaluation ======

Experienced psychiatrists see every type of non-fatal suicide behavior and thoughts. We become familiar with its intricacies and nuances. A good way to thinking about suicidal thoughts and behavior is to think of two dimensions, lethality and intentionality.  --- //[[dhawann@uthscsa.edu|Nikhil Dhawan, MD]] 2020/08/03 19:40//

==== Lethality ====
Ask yourself how lethal was the attempt or how lethal is the plan. Did they say they will kill themselves by continuing to smoke? Or did they attempt suicide by a lethal means, for example, missed gunshot to the face? Did the patient require medical admission or ICU stay after the attempt. Were there lab abnormalities or wounds that needed suturing? Also it may be good to know the statistics of completed suicide. Here is the data for 2017 from the  [[https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf|CDC]].
  - Firearms (23,854 deaths, 50.5%)
  - Hanging/suffocation (13,075 deaths, 27.7%)
  - Poisoning (6,554 deaths, 13.9%)

Even though we see overdose most commonly on our inpatient unit, it accounts for a minority of cases of completed suicide. However, overdose death from drugs is another common cause of death and it's unclear how much that would be counted as a suicide. Drug-induced death resulted in 73,990 deaths in 2017.
==== Intentionality ====
Ask yourself how certain the patient wants to die. Personally, I look for the patient making an argument that it would be best if they died. For example, I am a bad mother and my kids would be better off if I was dead. In addition, you can look for planning behavior and saying goodbyes to their family. We often see patients who attempt suicide impulsively and are not that intentional about it. Perhaps, the most intentional suicides result in death so we see them rarely.  --- //[[dhawann@uthscsa.edu|Nikhil Dhawan, MD]] 2020/08/03 19:40//

==== Suicide Risk Assessment ====

I find the SAFE-T assessment from SAMHSA to be quite accurate in assessing suicide risk and often gives you the correct intervention. You can find it [[https://store.samhsa.gov/sites/default/files/d7/priv/sma09-4432.pdf|here]].



====== Suicide Video ======

<html>
<iframe width='480' height='290' scrolling='no' src='https://www.washingtonpost.com/video/c/embed/d2cee450-fb08-11e7-9b5d-bbf0da31214d' frameborder='0' webkitallowfullscreen mozallowfullscreen allowfullscreen></iframe>
<li><a href="https://www.washingtonpost.com/video/c/embed/d2cee450-fb08-11e7-9b5d-bbf0da31214d">Video link</a></li>
</html>

====== Physician Suicide ======

  * [[https://www.washingtonpost.com/national/health-science/what-ive-learned-from-my-tally-of-757-doctor-suicides/2018/01/12/b0ea9126-eb50-11e7-9f92-10a2203f6c8d_story.html|Washington Post article by Dr. Wible.]]
  * [[https://www.cmaj.ca/content/190/14/E447.long|Editorial on Physician Suicide]]
  * [[https://pubmed.ncbi.nlm.nih.gov/26535958/|Prophylactic use of CBT in medical interns]]