Lest treatment abet suicide.
Epidemiologic data have identified risk factors, such as major depressive illness and sedative/alcohol addiction, that can help the clinician detect potentially suicidal persons. Evidence of subtle differences in the pattern of suicidality in bipolar and unipolar depressive illnesses has emerged. Suicide occurs early in unipolar episodes and intensifies along with increasing agitation and worsening melancholic symptoms. In bipolar depressive episodes, suicidality becomes an issue late in the course of a single episode, and illness severity and lethality are progressively aggravated by each affective relapse. Safe, effective treatment for suicide patients is the responsibility of the individual clinician and depends on neuropsychiatric variables, proper therapy, and direct and honest communication between patient and clinician. Adamant avoidance of division of primary clinical responsibility among cooperating specialists and clinician obstinancy when dealing with third parties can help prevent suicides. Early identification of psychosis, sedativism and subtle organicity are imperative. Pharmacotherapy usually equates to the fastest acting, most effective antidepressant drug, but some patients require electroconvulsive therapy to reduce suicidality. Involvement is the essence of psychotherapy in suicide management.
Himmelhoch
J M
JM
Department of Psychiatry, University of Pittsburgh, School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.
D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D003134:Commitment of Persons with Psychiatric Disorders; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D011613:Psychotherapy; D000092864:Suicide Prevention