Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Guidelines for decreasing the risk of suicide
Clinical Question
What screening and management tools should be used to prevent suicide in patients at high risk?
Bottom line
These guidelines, developed jointly by the US. Departments of Veterans Affairs and Defense, highlight the need to identify patients already deemed to be at risk for suicide and categorizing their risk as low, intermediate, or high. High risk patients and many patients at intermediate risk should be hospitalized; in the short term, acute treatment with ketamine, lithium, or clozapine, depending on the underlying cause, can be considered. Cognitive behavioral therapy or dialectical behavior therapy can be used after the acute risk is mitigated. A series of algorithms for risk identification, evaluation, and management are on the website [LINK TO https://annals.org/aim/fullarticle/2748922/assessment-management-patients-risk-suicide-synopsis-2019-u-s-department?searchresult=1] 5
Reference
Study design: Practice guideline
Funding: Government
Setting: Various (guideline)
Synopsis
These guidelines update the previous 2013 guidelines issued jointly by two U.S. groups. They are based on a systematic review [LINK TO doi:10.7326/M19-0869] of randomized controlled trials and other systematic reviews of strategies for treatment of adults at risk for suicide. The guideline development group comprised clinicians from different disciplines and specialties but did not include a patient representative. The group members had no financial conflicts of interest. Some of the recommendations are more clear than others. The recommendations (there are 22 of them) start by screening of patients for suicide who present with warning signs (and not screening of the general public). The next step is to determine whether the person is at low, intermediate, or high risk of suicide. High risk patients should be hospitalized. Patients at intermediate risk may be managed as outpatients if frequent contact and support systems are available. Patients at low risk should be treated for depression if warranted or decreasing isolation by strengthening social support. The guidelines suggest consideration of ketamine infusion for rapid amelioration of suicide ideation or lithium in patients with unipolar depression or bipolar disorder; clozapine can be considered in patients with schizophrenia or schizoaffective disorder. Cognitive behavioral therapy or dialectical behavior therapy can be used to decrease a second attempt at suicide.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Subject: Awareness to protect the risk of SUICIDE of human.
Dear respected Team-SIR/MAM-CMA-Canada,
Thank you my dear respected SIR/MAM to give me the above medical health subject -Guidines of decreasing the Rick of SUICIDE.
To protect SUICIDE of the people, we should keep health awareness which is mentioned below for patients/clients:
1.Daily exercise/walking /yoga /recreation etc.
2.Reading good books ,watching good movies, national geography TV channel, Discovery TV channel, children learning movies.
3.Stopping smoking and addiction life styles for life long.
4.Avoiiding fat foods.
5.No Indiscipline life styles .
6.No violence roles .
7. Education and Training for the growth of human life.
8.Joining social family marriage good programs/parties for social development.
9.Keeping good relations with own family members.
10. Keeping friendly atmosphere with all in society.
11.Respect ,love and humanity to patients/clients.
12.Obey parents and Teachers counseling.
13.Good married life styles after higher education/Training to join professional roles for life safety.
15.Sptituality life styles and polite behavior patterns.
16.Good behavior patterns with all in own family for peace and human life growth.
17.Daily bath
18. Prescribed medicine and counseling by doctors/psychologists/psychiatrists/
Nurse practitioner doctors/health care practitioners etc.
So,we should keep health awareness to prevent SUICIDE of human.
Respectfully.
Dr.Muhammnad Arif Rana
Global Family Doctor (LDM-224)-WONCA at SIG Based in Manikganj-Bangladesh.
Health Professional member-ID -52698-
MDS-USA
International Resident Member (IMG)-ID-680777
Associate Member -FDA-UK
Email:muhammadarifrana3@gmail.com
Date : November 05-2019-Tuesday-07:15 PM.
Best wishes and Respectfully.
Decreasing risk of suicide
The guidelines presented contain hardly anything new, and they are unlikely to have much impact on the rising rate of suicides. They utilize the medical model, which is unhelpful for most emotional problems, including most suicides. Here I would like to propose another model, seeing self-harm and suicide as emotional patterns gone awry.
The basic assumptions are that self-harm and suicide, rather than symptoms of a disease, are primitive emotional patterns, with the primary purpose of getting help from higher powers (no religious connotations intended.) Like most emotional patterns, these patterns originate in early childhood when emotions are the main means of communication, and parents are the higher powers. A neglected child whose parents can ignore him when he is crying or otherwise seeking attention, who gets help and attention only when he is in harm's way or doing himself harm, learns that harming himself is the most powerful way to get the help he needs. Typically, these are individuals lacking the appropriate skills and willingness to seek help, and when they need help, they are compelled to harm themselves instead. An effective strategy to deal with self-harm then is both cognitive (understanding that the purpose of self-harm is getting help) and behavioral (learning where and how to get the help needed). Using this model in psychiatric office practice for over 25 years, with only one exception, I did not need to use hospitalization to prevent suicides. Should this view of suicide become more prevalent than the medical model, we could maybe see a reduction in suicide rates.