APA Guidelines

Assessment and
Treatment of Patients with
Suicidal Behaviours

DR.ALIZA AZHAR
PGT
 PSYCHIATRIC MANAGEMENT
1. ESTABLISH & MAINTAIN A THERAPEUTIC
ALLIANCE
2. ATTEND TO PATIENT’S SAFETY
3. DETERMINE A TREATMENT SETTING
4. DEVELOP A PLAN OF TREATMENT
5. COORDINATE CARE AND COLLABORATE
WITH OTHER CLINICIANS
6. PROMOTE ADHERENCE TO THE
TREATMENT PLAN
 PSYCHIATRIC MANAGEMENT

7.PROVIDE EDUCATION TO THE PATIENT AND

FAMILY

8.REASSESS SAFETY AND SUICIDE RISK

9.MONITOR PSYCHIATRIC STATUS AND

RESPONSE TO TREATMENT

10.OBTAIN CONSULTATION,IF INDICATED

SPECIFIC TREATMENT MODALITIES

 1.ESTABLISH AND MAINTAIN
A THERAPEUTIC ALLIANCE
• BUILD TRUST

• ESTABLISH MUTUAL RESPECT

• DEVELOP A THERAPEUTIC RELATIONSHIP

• USE OF EMPATHY

• MAINTAIN A BALANCE B/W RESPONSIBILITY OF

PATIENT’S CARE AND PATIENT’S LIFE

• AN AWARENESS OF TRANSFERENCE AND

COUNTERTRANSFERENCE
2.ATTEND TO THE PATIENT’S
SAFETY

• OBSERVATION ON A ONE-TO-ONE BASIS

• CLOSED-CIRCUIT TELEVISION MONITORING

• REMOVING POTENTIAL HAZARDOUS ITEMS

FROM ACCESS OF PATIENT

• SECURING PATIENT’S BELONINGS

• PROHIBITING ANY GUNS IN EMERGENCY

AREAS
 3.DETERMINE A TREATMENT
SETTING
ADMISSION INDICATED ADMISSION MAY BE RELEASE AND FOLLOW
NECESSARY UP
PSYCHOTIC MAJOR PSYCHIATRIC ILLNESS ATTEMPT REACTION TO A
PRECIPITATING EVENTS

ATTEMPT PAST ATTEMPTS,MEDICALLY SERIOUS PLAN/METHOD AND INTENT HAVE LOW

VIOLENT,LETHAL,PREMEDIATED LETHALITY

AVOIDED RESCUE OR DISCOVERY ACUTE NEUROLOGICAL PATIENT STABLE AND SUPPORTIVE

DISORDER,CANCER,INFECTION LIVING SITUATION

INTENT STILL PRESENT LACK OF RESPONSE TO OUTPATIENT PATIENT ABLE TO COOPERATE WITH
CARE RECOMMENDATIONS AND FOLLOWUP

REGRET ON SURVIVAL NEED OF SUPERVISED CARE FOR

MEDICATION TRIAL OR ECT

MALE,>45 YR,NEW ONSET NEED FOR SKILLED

ILLNESS/IDEATION OBSERVATION,ASSESSMENTS

LIMITED SOCIAL SUPPORT LIMITED SOCIAL SUPPORT

METABOLIC,TOXIC,INFECTIOUS LACK OF ACCESS TO OUTPATIENT

ETIOLOGY REQUIRING WORKUP FOLLOW-UP
 4. DEVELOP A PLAN OF
TREATMENT
• DEVELOP A PLAN INTEGRATING A RANGE OF
BIOLOGICAL AND PSYCHOSOCIAL THERAPIES

• INCLUDE FAMILY AND OTHER SIGNIFICANT

SUPPORTS IN TREATMENT PLANNING PROCESS

• GOAL TO REDUCE RISK THAN TO ‘ELIMINATE’ RISK

• TREATMENT OF ASSOCIATED PSYCHIATRIC

ILLNES

• EARLY STAGE REQURIES MORE INTENSE FOLLOW-

UP
 5.COORDINATE CARE AND
COLLABORATE WITH OTHER
CLINICIANS
• CLEAR ROLE DEFINITIONS,REGULAR COMMUNICATION
,ADVANCE PLAN FOR MANAGEMENT OF CRISES

INPATIENT SETTING OUTPATIENT SETTING

TEAM TEAM
PSYCHIATRISTS EXPERTS IN OTHER
TREATNENT MODALITY
NURSES ANOTHER PSYCHIATRIST

SOCIAL WORKERS

PSYCHOLOGISTS
 6.PROMOTE ADHERENCE TO
THE TREATMENT PLAN
• SPECIFIC COMPONENTS OF A MESSAGE THAT IMPROVES
ADHERENCE

 WHEN AND HOW OFTEN TO TAKE THE MEDICINE

 SOME MEDICATIONS TAKE SEVERAL WEEKS TO TAKE

ACTION

 NEED TO CONTINUE MEDICATION EVEN AFTER FEELING

BETTER

 NEED TO CONSULT WITH THE DOCTOR BEFORE

DISCONTINUING MEDICATION

 WHAT TO DO IF PROBLEMS OR QUESTIONS ARISE

7.PROVIDE EDUCATION TO THE
PATIENT AND THE FAMILY
• PROVIDE INFORMATION THAT PSYCHIATRIC ILLNESSES ARE
REAL AND EFFECTIVE TREATMENT IS CRUCIAL

• INFORM FAMILY ABOUT THE ROLE OF PSYCHOSOCIAL

STRESSORS IN PRECIPITATING OR EXACERBATING
SUICIDALITY

• EDUCATION REGARDING AVAILABLE TREATMENT

OPTIONS,INFORMED DECISIONS,ANTICIPATE SIDE-EFFECTS
& ADHERE TO TREATMENTS

• IMPROVEMENT IS NOT LINEAR & RECOVERY MAY BE

UNEVEN
7.PROVIDE EDUCATION TO THE
PATIENT AND THE FAMILY
• DISCUSS OPENLY ABOUT SUICIDE

• HISTORY OF SUICIDE IN FAMILY MAY INCREASE RISK BUT

DOESN’T MAKE SUICIDE INEVITABLE.

• EDUCATE ABOUT SYMPTOMS THAT MAY INDICATE

WORSENING OF CONDITION.
 8.REASSESS SAFETY AND
SUICIDE RISK

• REASSESSMENT AT CRITICAL STAGES OF TREATMENT

 CHANGE IN LEVEL OF PRIVILAGE

 ABRUPT CHANGE IN MENTAL STATE

 BEFORE DISCHARGE

• BEHAVIOURS ASSOCIATED WITH AN ACUTE INCREASE IN

RISK

 GIVING AWAY POSSESSIONS

 READYING LEGAL OR FINANCIAL AFFAIRS

 GOODBYE MESSAGES
 9.MONITOR PSYCHIATRIC STATUS
AND RESPONSE TO TREATMENT

• ONGOING MONITORING NEEDED TO DETERMINE THE

PATIENT’S SYMPTOMS AND RESPONSE TO TREATMENT

• SETBACKS DO NOT NECESSARILY INDICATE TREATMENT IS

INEFFECTIVE.

• CHANGE IN PSYCHIATRIC STATUS OR EMERGENCE OF NEW

SYMPTOMS MAY INDICATE NEED FOR DIAGNOSTIC
REEVALUATION,CHANGE IN TREATMENT PLAN.
 10.OBTAIN CONSULTATION,IF
INDICATED
• CONSULTING/SUPERVISION FROM A COLLEAGUE IN
MONITORING AND ADDRESSING COUNTERTRANSFERENCE.

• IMPORTANT IN AFFIRMING APPROPRIATENESS OF PLAN AND

SUGGESTING OTHER APPROACHES.
 SOMATIC THERAPIES

• ANTIDEPRESSANTS
• LITHIUM(14-FOLD DECREASE)
• ANTIPSYCHOTIC AGENTS
• ANTIANXIETY AGENTS
• ECT
 PSYCHOTHERAPIES

• CBT
• PSYCHODYNAMIC THERAPY
• INTERPERSONAL THERAPY
• DIALECTICAL BEHAVIOUR THERAPY