Psych · Emergency psychiatry — suicide risk
Suicide risk assessment
Also known as Suicide risk · Suicidality · Safety planning · Means restriction · Self-harm risk assessment · Stanley-Brown safety plan · C-SSRS · Suicide prevention
Exam-exhaustive fellowship reference on suicide risk assessment and management — epidemiology; static vs dynamic vs protective factors; ideation-to-action models; structured interview and C-SSRS concepts; means restriction; Stanley-Brown safety planning; disposition; post-discharge peak risk; lithium and clozapine anti-suicide evidence; special populations; CASC communication. Non-stigmatising language. FRANZCP-primary, globally tagged.
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Meet the patient
A 34-year-old teacher is in the resus bay two hours after a paracetamol overdose. She is tearful, lucid, and says she does not want to talk. Her partner, waiting outside, tells you she has been sacked, has stopped sleeping, and three nights ago gave him her late mother's ring "for safekeeping". She is due to see her GP next month.[1][20]
Two questions are now live, and every examiner will press both: is she safe to go home tonight? and what is your plan for the next week? Everything below exists to answer those two questions at consultant depth — and to do so without pretending you can foresee what no scale can foresee.[16][13]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References20Show ledgerHide ledger
- [1]Turecki G, Brent DA Suicide and suicidal behaviour Lancet, 2016.PMID 26385066
- [2]Mann JJ Neurobiology of suicidal behaviour Nat Rev Neurosci, 2003.PMID 14523381
- [3]Van Orden KA, Witte TK, Cukrowicz KC, et al. The interpersonal theory of suicide Psychol Rev, 2010.PMID 20438238
- [4]O'Connor RC, Kirtley OJ The integrated motivational-volitional model of suicidal behaviour Philos Trans R Soc Lond B Biol Sci, 2018.PMID 30012735
- [5]Nock MK, Borges G, Bromet EJ, et al. Cross-national prevalence and risk factors for suicidal ideation, plans and attempts Br J Psychiatry, 2008.PMID 18245022
- [6]Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults Am J Psychiatry, 2011.PMID 22193671
- [7]Stanley B, Brown GK, Brenner LA, et al. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department JAMA Psychiatry, 2018.PMID 29998307
- [8]Brown GK, Ten Have T, Henriques GR, et al. Cognitive therapy for the prevention of suicide attempts: a randomized controlled trial JAMA, 2005.PMID 16077050
- [9]Linehan MM, Comtois KA, Murray AM, et al. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder Arch Gen Psychiatry, 2006.PMID 16818865
- [10]Rudd MD, Bryan CJ, Wertenberger EG, et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up Am J Psychiatry, 2015.PMID 25677353
- [11]Cipriani A, Hawton K, Stockton S, et al. Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis BMJ, 2013.PMID 23814104
- [12]Meltzer HY, Alphs L, Green AI, et al. Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT) Arch Gen Psychiatry, 2003.PMID 12511175
- [13]Chung DT, Ryan CJ, Hadzi-Pavlovic D, et al. Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis JAMA Psychiatry, 2017.PMID 28564699
- [14]Qin P, Nordentoft M Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers Arch Gen Psychiatry, 2005.PMID 15809410
- [15]Olfson M, Wall M, Wang S, et al. Short-term Suicide Risk After Psychiatric Hospital Discharge JAMA Psychiatry, 2016.PMID 27654151
- [16]Large MM, Ryan CJ, Carter G, et al. Can we usefully stratify patients according to suicide risk? BMJ, 2017.PMID 29042363
- [17]Large M, Kaneson M, Myles N, et al. Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time PLoS One, 2016.PMID 27285387
- [18]Chan MK, Bhatti H, Meader N, et al. Predicting suicide following self-harm: systematic review of risk factors and risk scales Br J Psychiatry, 2016.PMID 27340111
- [19]Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review Lancet Psychiatry, 2016.PMID 27289303
- [20]Cavanagh JT, Carson AJ, Sharpe M, et al. Psychological autopsy studies of suicide: a systematic review Psychol Med, 2003.PMID 12701661