Antipsychotics Antipsychotics are considered the mainstay of therapy for patients with psychotic disorders who present with clinical indications of suicidal ideation and behavior. First-generation antipsychotics have demonstrated significant efficacy in the treatment of delusions and hallucinations. They are also indicated for the treatment of confusion, aggression, agitation, and major affective disorders. In emergency settings where suicidal patients present with high agitation, first-generation antipsychotics have also demonstrated beneficial effects in reducing suicide risk. Clinically, the only downside to the use of older antipsychotics in suicide therapy is the associated risk of extrapyramidal neurological side effects and the possibility of a worsened depression state. This problem is solved by the Antianxiety Agents Anxiety is a modifiable risk factor for suicide, with a sizable percentage of suicidal youth presenting with different forms of anxiety. Acute suicide risks are also commonly associated with severe psychic anxiety, agitation, and panic attacks. The research on the clinical benefits of anxiolytics in the management of suicide is limited, with not enough evidence to suggest a long- or short-term reduction in suicidality score. However, this class of medications is widely used as an option for the resolution of anxiety associated with suicidal ideation and behavior in some patients. Specifically, short-acting benzodiazepines are preferred to long-acting benzodiazepines in the mitigation of severe recurrent anxiety and agitation in suicide behavior. If sedation is considered useful in suicidal patients, especially those presenting with extreme agitation in an emergency setting, long- acting benzodiazepines may be selected as an antianxiety agent. These medications are likely to induce daytime sedation and temporarily resolve fits of agitation. Benzodiazepines or second- Electroconvulsive Therapy (ECT) Preliminary research on the potential benefits of ECT in the clinical management of suicide suggests a reduction of suicide risk in patients optimally managed with this option. ECT has received wide acceptance as a therapy method for acutely suicidal patients with severe depressive illness. Additionally, this therapy option has shown immense potential in the management of patients with manic or mixed episodes of bipolar disorder and schizophrenia. Since the clinical effects of ECT in suicidal patients are without any significant time delay, it is also indicated in suicidal patients for whom a delay in the initiation of therapy may be fatal. Specifically, patients refusing to eat primarily due to psychosis or depressive symptoms and those with catatonic features may benefit from the timely institution of ECT as a therapy for suicidal ideation and behavior. Compared with other therapy forms in the management of SIB, ECT has also been proven to be relatively safe. The APA guidelines on the management of suicidal ideation and behavior recognize ECT as Nonpharmacological Therapies Psychotherapies are instituted as a supplementary therapy to pharmacotherapy and electroconvulsive therapy. They play a leading role in the clinical management of suicidality in adults and adolescents. The clinical rationale for the use of psychotherapy in SIB is primarily based on clinical consensus suggesting that psychosocial interventions and selected psychotherapy approaches are beneficial in the management of suicidal ideation and behavior. This is consistent with the Cognitive-Behavioral Therapy The effectiveness of cognitive-behavioral therapy in treating depression and related symptoms such as hopelessness has long been proven by different cohort studies and practical observation studies (Gautam et al., 2020). Given this evidence, cognitive-behavioral therapy is also expected to offer significant clinical benefits in the management of suicidal ideation and behavior in adults and adolescents. However, evidence supporting this logical deduction is limited. Many randomized clinical trials have been conducted to examine the direct effects
introduction of second-generation antipsychotics. Compared with the older class of antipsychotics, second-generation antipsychotics are associated with a lower risk of extrapyramidal neurological side effects. This new class of first-generation antipsychotics shows significant efficacy in the management of depressive forms and suicidality risks presented by SIB patients. This second-generation antipsychotics are prescribed for suicidal patients who need the enhanced treatment adherence that is afforded by a depot form of medication. First-generation antipsychotics are also prescribed for patients where second- generation antipsychotics have provided no significant effect on depressive disorders and psychosis. generation antipsychotics are also indicated for persistent severe insomnia, a modifiable risk factor for suicide. The APA guidelines on the use of benzodiazepines in suicidal patients emphasize a warning that benzodiazepines may occasionally disinhibit aggressive and dangerous behaviors. These medications may also enhance impulsivity in patients with borderline personality disorders. Discontinuation of benzodiazepines, if advised, should be done only by dose tapering. This method of discontinuation progressively reduces the administered dose over some time until the drug is finally withdrawn. Sudden withdrawal of benzodiazepines has been linked with a rebound increase in suicide risk. Second-generation antipsychotics and anticonvulsants are also widely prescribed as an alternative to benzodiazepines. Gabapentin and divalproex are popular medications in these classes. a therapy option for pregnant suicidal patients, for individual’s other medications are contraindicated for, and for those who cannot tolerate or respond adequately to other medications. In patients with chronic suicidal ideation and behavior and borderline personality disorder, ECT should be used as a therapy for comorbid disorders and especially comorbid major depressive disorders. Although ECT is widely used globally in exceptional cases of suicidal ideation and behavior, there is limited research evidence supporting its long-term use. This also holds for the sustained reduction of suicidal risk factors and behaviors. The APA guidelines on the use of ECT in these cases prescribes close clinical supervision and additional therapy during the subsequent weeks after an acute course of ECT. Close clinical supervision should be focused on clinical benefits, the need for therapy withdrawal, and monitoring any potential side effects. results of studies demonstrating the efficacy of psychotherapy in the treatment of disorders such as depression and borderline personality disorder associated with increased suicide risk. Combination therapies of psychotherapy and pharmacotherapy in individuals presenting with SIB are receiving wide support in medical circles. The most widely studied psychotherapy modules include the following. of cognitive-behavioral therapy focused on teaching problem- solving techniques to individuals with an increased risk of suicide attempts. Results gathered after a one-year follow-up period indicated that problem-solving techniques addressed in cognitive-behavioral therapy significantly improved the risk of suicide attempts compared to control subjects. The within- person ratings of depression, suicidal ideation, command hallucination, and hopelessness also improved significantly in the study population compared to the control group.
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Book Code: PYMA2024
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