Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] 194 INTRODUCTION Dr. Targum: Hospital emergency departments see a lot of people who are seriously thinking about suicide or have made suicide attempts. In fact, emergency departments (ED) in the United States treat over 500,000 people annually for suicide-related issues. 1,2 Within many healthcare systems, the ED has become a critical thoroughfare (the default option) for acute and chronically suicidal patients. 1 Mills et al 3 found that the ED had the second highest number of reported completed suicides and attempts within the Veterans Affairs (VA) healthcare system and was second only to inpatient psychiatric units. 3 Suicide attempts leading to ED visits are not restricted to any age group, ethnicity, or socio-economic status and are not always associated with psychiatric comorbidity like depression, conduct disorder, or substance abuse. Suicide attempts leading to ED visits occur in adolescents as well as the elderly, may be impulsive or deliberate, may follow alcohol intoxication, and vary widely in the actual intent to die. 4–7 The obvious high risk of a repeat suicide attempt generates an urgency to make an accurate assessment and create a safe, yet plausible treatment plan. ED physicians need to quickly assess the potential lethality of suicidal patients and determine whether to retain them (hospital admission) or discharge them. The majority of suicide attempt patients seen in the ED are discharged without hospitalization after medical stabilization and psychosocial evaluation. 6 Yet, these patients still have a high risk for repeated attempts. Up to 25 percent of these suicide attempters return to the ED after another attempt, and 5 to 10 percent eventually die by suicide. 1 Given this context, it is intriguing that hospitalization rates following suicide attempt-related ED visits actually decreased from 49 percent to 32 percent during the same time period (1992–2001) that ED visits for suicide attempts had increased by 47 percent. 6 Clearly, the ED is a vital setting for suicide prevention and may be the only access to healthcare available for some patients. Of course, the busy ED has to deal with cardiac arrests, gun shot wounds, sick babies, and every other conceivable medical emergency at the same time that they assess a suicidal patient. For this column, I discuss the assessment of suicidal patients with two physicians who work at the very busy ED at Tufts Medical Center in downtown Boston, Massachusetts. Their views go beyond the theoretical and reflect the experience and wisdom of physicians who work on the front line of healthcare. Dr. Frank Friedman is an Assistant Professor of Emergency Medicine at Tufts University School of Medicine and the Director of Prehospital Care and Emergency Preparedness at Tufts Medical Center. Dr. Manuel N. Pacheco is an Assistant Professor of Psychiatry at Tufts Research to Practice ASSESSMENT OF SUICIDAL BEHAVIOR IN THE EMERGENCY DEPARTMENT by Steven D. Targum, MD; Frank Friedman, MD; and Manuel N. Pacheco, MD, FAPM, DFAPA Innov Clin Neurosci. 2013;10(9–10):194–200

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