148 279 If true the administration of anti anxiety andor sedative medications

148 279 if true the administration of anti anxiety

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148, 279 If true, the administration of anti-anxiety and/or sedative medications that work immediately may be life saving. However, the majority of psycho- tropic drugs take time to be effective, meaning both side- and therapeutic-effects will be experi- enced outside the average six to seven day hospitalization. 43, 119, 258, 284 At least conceptually, recession of suicidal ideation, intent, and attempts occurs as acute symp- toms of the psychiatric disorder recede. Given this formulation, Gary Jacobson warns that “There is a danger that suicidality will be treated as a mere symptom to be added to a checklist and to be reduced and in that sense treated similar to other symptoms such as hallucinations, depression or anxiety.” 123 Indeed, suicide attempts or suicidal ideation are not considered psychiatric disorders, per se. Rather, these and related suicide behaviors are more considered untoward outcomes of any one of a number of psychiatric disorders. Inpatient psychiatry pairs suicide behaviors with one or more psychiatric illnesses, where the bulk of therapeutic attention goes to the diagnosed illnesses. 45, 62, 119, 277, 285-287 Suicide attempts and ideation are treated like symptoms of some other condition. Historically, alcoholism was once considered to be a choice, a vice, a moral failure, an acquired habit, and/or a symptom of another condition. Only recently has alcoholism acquired the status of an authentic disease. 288 Perhaps suicide-risk should be given the same status. What should constitute a specific anti-suicide, psychotherapeutic intervention that begins the mo- ment the patient is admitted and continues for the duration of the psychiatric hospitalization and, prominently, is continued beyond the hospital stay? Unfortunately, discontinuities of care are com- mon since there are no explicit, directive standards for continuity. Specific psychotherapeutic man- agement of suicide risk is not what inpatient psychiatry has been traditionally all about. 123, 277, 285, 289 Most attention has been given to behavioral monitoring, denying access to means and the safety features of the physical space. 123, 275, 277, 278, 285, 289, 290 A variety of inpatient suicide-prevention psy- chotherapies have been tried, but these efforts are highly variable and have not moved far outside the demonstration hospitals. 246, 291, 292 Change is slow and hampered by the near absence of text- books or professional organizations devoted to psychiatric inpatient care.
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Continuity of Care for Suicide Prevention and Research 46 Since dialectal behavioral therapy (DBT) was originally conceived as a means to counter patients’ often ambivalent progress toward suicide, this form of cognitive therapy might well be one of the mainstays of inpatient care. Supporting this assertion are randomized trials of DBT on small samples of inpatients; however, there is scant evidence that the results from these trials have motivated further research aimed at placing DBT in community short-stay hospitals.
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