StopASuicide_DJacobs_SuicideAssessment_slides

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Suicide Assessment Suicide Assessment University of Michigan Depression Center University of Michigan Depression Center Colloquium Series Colloquium Series December 19, 2003  December 19, 2003  Douglas Jacobs, MD Douglas Jacobs, MD Associate Clinical Professor of Psychiatry, Associate Clinical Professor of Psychiatry, Harvard Medical School Harvard Medical School Chair: American Psychiatric Association Workgroup, Practice Chair: American Psychiatric Association Workgroup, Practice Guidelines on Suicidal Behavior Guidelines on Suicidal Behavior Founder: National Depression Screening Day Founder: National Depression Screening Day
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Questions about Suicide Assessment 1. How should clinicians use knowledge of suicide risk factors in their assessment of patients at risk? 2. Which diagnoses, risk factors and symptoms should most concern clinicians? 3. Under what circumstances, if any, should a clinician ask a patient to sign a no-suicide contract? 4. Is psychotherapy always recommended for patients at risk for suicidal behavior?
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Questions about Suicide Assessment 5. Is it ever acceptable to defer or avoid hospitalizing a suicidal patient? 6. Should we expect antidepressants or mood stabilizers to lower suicide risk? 7. What are the most important elements to document in a suicide risk assessment?
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SUICIDE PREDICTION vs. SUICIDE ASSESSMENT Suicide Prediction refers to the foretelling of whether suicide will or will not occur at some future time, based on the presence or absence of a specific number of defined factors, within definable limits of statistical probability Suicide (risk) Assessment refers to the establishment of a clinical judgment of risk in the very near future, based on the weighing of a very large mass of available clinical detail. Risk assessment carried out in a systematic, disciplined way is more than a guess or intuition – it is a reasoned, inductive process, and a necessary exercise in estimating probability over short periods.
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COMPONENTS OF SUICIDE ASSESSMENT Appreciate the complexity of suicide / multiple contributing factors Conduct a thorough psychiatric examination, identifying risk factors and protective factors and distinguishing risk factors which can be modified from those which cannot Ask directly about suicide; The Specific Suicide Inquiry Determine level of suicide risk: low, moderate, high Determine treatment setting and plan Document assessments
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SUICIDE: A MULTI-FACTORIAL EVENT Neurobiology Severe Medical Illness Impulsiveness Access To Weapons Hopelessness Life Stressors Family History Suicidal Behavior Personality Disorder/Traits Psychiatric Illness Co-morbidity Psychodynamics/ Psychological Vulnerability Substance Use/Abuse Suicide
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Areas to Evaluate in Suicide Assessment Psychiatric Illnesses Comorbidity, Affective Disorders, Alcohol / Substance Abuse, Schizophrenia, Cluster B Personality disorders.
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