September 23, 2007

What The Hell Kind Of Suicide Assessment Is This?

Do you know how many psychiatry journals there are?  A lot.  I get 8 peer reviewed journals mailed to my house, not to mention the shopping bag/week of "Insights" and "Reviews" and "Expert Series."   What the hell could be in all these journals, other than drug ads?  Is the field evolving that rapidly?  I mean, just how much info can there be about Lamictal?

But I'm happy to announce that the hundreds of articles are all top notch, cutting edge stuff.  Let's look at a recent one, about how to conduct and document a suicide assessment. 

I'm a busy man, with a lot to read-- what are the main, state-of-the-art points that I need to know about suicide?  


 clinical point 1


Also suggested was listening to patients, preferred over caning patients, which can sometimes be misconstrued as insensitive. 


How can I tell who's at risk?  Blood tests, cortisol levels, what? 

clinical point 2 

Crap.  Wrong again.  All this time I've been looking for breast implants.  Turns out, other signs include: frequent renting of Girl, Interrupted; being Anne Sexton; going through puberty in Ohio; mapquesting the longest way to the hospital; listening to rock music.

Keep in mind: these are the key points the editors and peer reviewers felt important enough to put in little sideboxes.  Aces.  Let's go on.  

What questions can be asked to help detect suicidality?



Wow.  Do the answers actually matter? 

Later the article discusses medico-legal risk.  That's what every psychiatrist wants to know: how to document a suicide assessment.  What should you write so that if, God forbid, the patient does kill himself, then it shows that you asked the right questions and did the best you could?    What advice is there for reducing medico-legal risk?  A sample write-up, perhaps?   

sample document

Great, finally-- this is exactly the kind of patient we want to know about-- complicated, but not currently suicidal.  Ok, what should I write in the assessment?  To reduce medico-legal risk?  I'm have a Moleskin, I'm taking notes:


sample assessment 

Does anyone in psychiatric journals ever get discharged?  Or are we in France?   The guy denies suicidality, and you're considering ECT?  This is like writing a pamphlet called, "Practical Tips For Driving In Snow" with only two sentences: "It's so much safer not to!  Have a Fanta!" (For a more practical, albeit not as well written, article on documenting the discharge of a suicidal patient, click there.)