Treating Suicidal Patients [Evidence-Based]

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Treating Suicidal Patients [Evidence-Based]

Summary:
– interview with Dr Thomas Ellis
– myths: 1&2
1) they are not the same as other patients – suicide is a specialised area – being intelligent & caring is not enough
2) no suicide contract – an outmoded (albeit well-intentioned) concept
– there is no empirical data to support their use
– in courts, there is no legal basis to them
– we are increasingly moving away from a control agenda to a collaborative process
– INSTEAD use a written safety plan (more practical) – agreement about what I can do in a crisis
3) cannot predict suicide in a patient
(No. 10 leading cause of death in the USA)
– courts do not require a clinician to never make a mistake (all competent professionals occasionally make a mistake – it is not incompetence / if due diligence has occurred (devote appropriate time to ask about suicide risk)
4) best practice to assess risk [ideation, plan, means, appearance, history of suicidal behaviours, talk to family members
– base entire assessment on what patient says
– CASE approach (Shea): Chronological Assessment of suicidal Events) *****
– history & recent experience
[both what & how to ask]
– CAMS (Jobes) – what is behind it suicidal, stress, self-hatred ******
– co-develops a treatment plan
5) belief that suicide is based on impulsivity
– some patients say this, but research is increasingly is showing they do not come out of the blue – long standing history of trauma, AOD, depression, use &/or psychological stress
6) stabilise crisis of suicidality, then move on with treatment of depression [standard model used by most clinicians]
– suicidal ideation/suicidality model is practiced much, but no data to support the model
– mood improves, but the risk remains
– suicidality while not a standalone diagnosis (despite push to have it included in the DSM-7) suicide still has residual risk
– sleep disturbance & suicide are highly-correlated, once controlled for depression
– Suicide Cognitions Scale************
8) suicide-specific therapy
– Marsha Linehan (DBT) – has a protective effect
– mentalising therapy (psychodynamic)
– BECK/CBT – methodical approach (manual)
9) always be clear – that our number one priority is the patient’s survival
10) suicide is often linked to:
– personal deficiencies in problem-solving skills
– improve these to address hopelessness
– perfectionism
– more flexible thinking in terms of judgment & thinking
– emotion regulation
– many say they cannot stand how to feel this / therefore learning skills in this area
[their suffering was legitimate / rather than take it off the table, we will put more things on the table for you to choose from in the time of a crisis]
11) risk Factors & Warning signs
– make the distinction
– risk factors – white, male, rural more than urban (very general)

– not depression or despair predict

– it is activating states such as intense anxiety, panic attacks, insomnia, agitation plus sad/hopeless (foot on brake & gas at the same time)

– see American Association for Suicidology or google warning signs for suicide
12) AAS Training Package

Q: what is it that sets suicide apart?
4 to 7% of people with depression die by suicide

Source: CBT Radio | CBT WNC podcast date – 6 September 2016

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