SUICIDE
Here are some suicide facts.
The biggest risk factor is a previous suicide attempt.
Females attempt suicide more frequently, but males are much more successful at getting the job done.
Family and religious involvement are protective factors
95% of those who successfully commit suicide have a psychiatric disorder.
Old men are the demographic group most likely to kill themselves.
Passive Suicidality
“I don’t want to go on living.”
Management is tricky. First ask yourself, is this patient reliable enough to stick to an outpatient plan?
Unreliable patients get committed (psychosis, comorbid psychiatric disorders, bad vibes).
Reliable patients warrant an outpatient safety plan (supportive family, religious, responsible vibes). Schedule follow up the next day. Lining up a short hospitalization or intensive outpatient program is probably a wise move.
Active Suicidality
“I want to kill myself.”
Commit them to a psychiatric unit.
Active Suicidality with a Plan
“I’m going to shoot myself tonight with my shotgun.”
Commit them to a psychiatric unit.
Once the patient is stabilized, what medications should be given?
Lithium lowers suicidality. It’s reasonable to add it on top of their SSRI / SNRI in severe depression.
Ketamine is an NMDA blocker. It can be given nasally. It can treat acute depression and suicidality.
Do NOT prescribe TCAs. Way too easy to OD on.