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Chapter 15 - The Suicidal Patient

Published online by Cambridge University Press:  02 January 2025

By
Ryan E. Lawrence
Edited by
Marsal Sanches  and
Jair C. Soares
Marsal Sanches
Affiliation:
McGovern Medical School, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, Texas
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Summary

Suicide is a major problem around the globe. Among various psychiatric diagnoses, schizophrenia confers the greatest risk to an individual, while depression confers the greatest risk to populations due to higher prevalence. Predicting suicide attempts with specificity is a major challenge for clinicians. Evidence-based screening and assessment tools exist, which can help standardize the evaluation process, but these tools have limited specificity, sensitivity, and negative predictive value. Best practice is to use these tools in the context of a full clinical assessment that includes a medical and psychiatric history, a mental status exam, obtaining collateral, and eliciting risk and protective factors. The stress-diathesis model posits that suicidal behavior is the result of complex interactions between an acute stressor and underlying neurobiological vulnerability. Evidence supports treating suicide risk through lethal means restriction, outreach after discharge, psychiatric medication where appropriate (antidepressants, lithium, clozapine, ketamine), psychotherapy (cognitive behavior therapy, dialectical behavior therapy), and safety planning. When clinicians identify suicide risk factors and provide appropriate interventions, lives are saved.

Keywords

suicidesuicide attemptsuicide assessmentsuicide neurobiologyself-harm
Type
Chapter
Information
Fundamentals of Clinical Psychiatry
A Practical Handbook
 , pp. 134 - 144
Publisher: Cambridge University Press
Print publication year: 2025

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References

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