Suicide psychiatric evaluation

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Suicide Microchapters

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Patient Information

Overview

Classification

Epidemiology and Demographics

Risk Factors

Screening

Physical Examination

Laboratory Findings

Psychiatric evaluation

Treatment

Medical Therapy

Psychotherapy

Pharmacotherapy

Prevention

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

Overview

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.

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.[1]
  • 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.[2][3]
"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 consideration 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

References

  1. "Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. American Academy of Child and Adolescent Psychiatry". J Am Acad Child Adolesc Psychiatry. 40 (7 Suppl): 24S–51S. July 2001. PMID 11434483.
  2. Chun TH, Mace SE, Katz ER (September 2016). "Evaluation and Management of Children and Adolescents With Acute Mental Health or Behavioral Problems. Part I: Common Clinical Challenges of Patients With Mental Health and/or Behavioral Emergencies". Pediatrics. 138 (3). doi:10.1542/peds.2016-1570. PMID 27550977.
  3. Press BR, Khan SA (June 1997). "Management of the suicidal child or adolescent in the emergency department". Curr. Opin. Pediatr. 9 (3): 237–41. PMID 9229162.



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