Table 1. Essential Elements Of The History In Potentially Suicidal Patients.
Current suicidal ideation, intent, and plan (ask specifically about each)
History of suicide attempts (include date, circumstances, and lethality of method)
Family history of suicide
History of mental illness (especially depression, schizophrenia, bipolar disorder, borderline personality, and anxiety disorders)
Intensity of current depressive symptoms
Current treatment regimen and response
Psychotic symptoms (especially auditory command hallucinations, thoughts of external control, and religious preoccupation)
Alcohol and drug use patterns
Concurrent medical illnesses, especially debilitating or painful conditions
Past or present history of violence/aggression
Recent life stressors (e.g., marital separation, job loss)
Current living situation (e.g., social supports, availability of weapon)
Family member contact information to corroborate details and assess safety of home conditions
Adapted from: Frierson RL, Melikian M, Wadman PC. Principles of suicide risk assessment. How to interview depressed patients and tailor treatment. Postgrad Med 2002 Sep;112(3):65-66, 69-71.
|Useful initial diagnostic tests in patients who have attempted suicide
may include an electrocardiogram, acetaminophen level, salicylate level,
and blood alcohol level. The ECG can be diagnostic in suicide attempters
who present with an altered mental status or unstable vital signs. In particular,
tricyclic antidepressant toxicity is suggested by
the presence of a rightward axis in the terminal 40-msec of the QRS complex
coupled with QRS widening.67
|In March 2004, the U.S. Food and Drug Administration issued a statement
requiring the manufacturers of several antidepressants
(fluoxetine, sertraline, paroxetine, fluvoxamine, citalopram,
escitalopram, bupropion, venlafaxine, nefazodone, and mirtazapine)
to include a warning statement that recommends close observation of adult
and pediatric patients treated with these agents for worsening depression
or the emergence of suicidality, particularly at the beginning of therapy
or when the dose either increases or decreases.49
|How's your health?||Self-perception of poor health is associated with a significantly increased risk of suicidal ideation, even in the absence of common mental and physical disorders.47||47. Goodwin R, Olfson M. Self-perception of poor health and suicidal ideation in medical patients. Psychol Med 2002 Oct;32(7):1293-1299. (Prospective; 4007 patients)|
|How did you come to feel this way?||Eighty-three percent of adolescent patients who had attempted suicide were not previously recognized as suicidal by their primary care physician.||How long have you felt this way?|
|substance abuse||Table 6. CAGE Screen For Alcohol (risk
factor for suicide)
C = "Have you ever felt you should Cut down on your drinking?"
A = "Have people Annoyed you by criticizing your drinking?"
G = "Have you ever felt bad or Guilty about your drinking?"
E = "Have you ever had a drink as an Eye-opener first thing in the morning to steady your nerves or help a hangover?"
Yes to two or more: probable alcohol abuse