Suicide psychiatric evaluation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Psychiatric evaluation

• Psychiatric evaluation is done by the clinicians with specialized training and experience in the psychiatric problems of children and adolescents or general medical emergency department clinicians.
• Psychiatric evaluation is done once the patient is medically stable.
• The mnemonic "MALPRACTICE" is used to ensure that all the areas for psychiatric evaluation are being covered.

"MALPRACTICE" mnemonic for evaluation of suicidal child or adolescent
M- Mental health	Does the patient have a psychiatric diagnosis?
	Is he or she taking psychotropic medications?
	Is there a family history of mental health illness?
A -Attempts	When did the patient first consider suicide?
	Has the patient tried to harm him- or herself before?
	Did he or she receive medical attention for that attempt?
L -Lethality	Did the patient want to die?
	Does he or she still want to?
	Does he or she have access to lethal means?
P -Plans	Is the patient able to make plans for the future?
	Will he or she graduate from school?
	What kind of job will he or she do?
R -Risk-taking	Is the patient engaging in activities that may be disguised attempts at self-harm?
	Is the patient engaging in unprotected sexual activity?
A -Alcohol and drugs	Were substances involved in the current attempt?
	For how long have substances been used?
	What substances are being used?
	When was the last use?
C -Conflict	Is there an interpersonal conflict that precipitated this event?
T -Trauma	Does the patient report having been physically or sexually abused?
	Has the patient been a witness to violence?
	Has the patient recently lost a loved one?
I -Impulsivity	Was the act premeditated?
	How much planning went into the suicide attempt?
	Was a suicide note written?
	Did the patient tell anyone about his or her plans?
C -Community resources	Does the patient have a social support system?
E -Exposure	Have other family members or friends attempted or completed suicide?
	Has the patient been exposed to suicide in the media?
	Is this attempt part of a suicide epidemic?

• A mental status examination should be done with consideartion of following components:
  • Appearance
  • Attitude
  • Behavior
  • Motor functioning
  • Attention
  • Concentration
  • Orientation
  • Memory
  • Affect
  • Speech
  • Language
  • Suicidal and homicidal ideation, plan, and intent
  • Thought content
  • Thought process
  • Perception
  • Intellectual functioning
  • Judgement
  • Insight