Algorithm C: Management of Patients at Acute Risk for Suicide
Figure 5. Identification of Risk for Suicide (continued)
Note: From “ VA/DoD clinical practice guidelines: Assessment and Management of Patients at Risk for Suicide,” by U.S. Department of Veterans Affairs, 2019. (https://www.healthquality.va.gov/guidelines/MH/srb/index.asp). In the public domain. Modifiable Risk Factors ● Modifiable risk factors are things that can be changed, such as depression ● Often, such risk factors can be reduced by certain iii. Collaborative identification of clear signs of crisis (behavioral, cognitive, affective, or physical) iv. Self-management skill identification, including things that can be done on the patient’s own to distract or feel less stressed
interventions, such as prescribing antidepressant medication for depression or decreasing isolation by strengthening social support. Evidence-based Treatment Evidence-based treatments to reduce repetition of suicide behavior as follows: 1. Nonpharmacologic treatments: • Cognitive-behavioral therapy–based interventions for suicide prevention • Dialectical behavior therapy: Problem-Solving therapy– based interventions 2. Crisis response plan: i. Semi-structured interview of recent suicidal ideation and chronic history of suicide attempts ii. Unstructured conversation about recent stressors and current complaints using supportive listening techniques
v. Collaborative identification of social support, including friends and family members who have helped in the past and who they would feel comfortable contacting in crisis vi. Review of crisis resources, including medical providers, other professionals, and the suicide lifeline vii. Referral to treatment, including follow-up appointments and other referrals as needed; consider protective factors 3. Pharmacotherapy for suicide prevention: • Ketamine infusion (among patients with suicidal ideation and major depressive disorder) • Lithium alone (among patients with bipolar disorder) or in combination with another psychotropic agent • Clozapine (among patients with either suicidal ideation or a history of suicide attempts)
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