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Patients who are suicidal are medical emergencies.
Once it has been established that a patient is high risk for suicide,
he must be protected at all costs. Admission into a psychiatric
hospital on one-to-one watch is crucial, making sure there are no
implements in the room, electrical cords, etc. that an individual
can use. When individuals are suicidal, they may become very creative
in their desperation, and it is very important to be aware of this.
Dr. John Mann of the New York State Psychiatric Institute reports
that about 60% of suicides usually occur in the context of a mood
disorder, yet only about 12% of those received a minimally effective
dose of an anti-depressant. There are still healthcare providers
who are reluctant to prescribe mediation. Anti-depressants should
definitely be used. The dilemma with this is that it takes 2-3 weeks
before a therapeutic dosage is reached. Anti-anxiety agents, as
well as sleep agents, are crucial to use in the beginning stages
of recovery. Suicidal patients usually have severe insomnia, and
do not sleep. Once we can get the individual to sleep and rested,
group therapy is much more effective. It is also crucial to start
anti-depressants immediately. As with all anti-depressants, this
author frequently advises to try one, and if one is not effective,
you have to tell the patient they may need to be switched to something
else down the road. This way, you predict a possible failure, informing
the patient there may be a need to try a different SSRI.
Clozaril is a medication that has recently been approved for individuals
with recurrent suicidal ideation and attempts. It has been approved
by the FDA for suicidal behavior in schizophrenics. There are side-effects
of this medication. Please see the article on psychiatric medication
on Peace and Healing.com.
Clearly precipitants should be addressed, as well as the lack of
coping mechanisms suicidal patients have at their disposal. Most
suicidal patients believe they have no coping mechanisms left, as
the ones they have been using have failed them. This author also
suggests as per Dr. Hammerschlag, that it is not so much the stress
of the event, but how an individual approaches the event, or the
stressor. Before that can be shared, however, we must initially
get the individual past the crisis. Once the patient’s suicide
risk decreases, it is a very important approach to take, i.e. teaching
the patient how to view stressors differently, as once the individual
feels empowered, and can successfully take on more stressors, suicidal
ideation (and attempts) decreases.
It is also important to note that we have to have some understanding,
and not be grandiose about the treatment of all suicidal patients.
We have to understand that a certain percentage of individuals will
kill themselves no matter what we do, despite medication or therapy.
We have to recognize this as a possibility. If we don’t, we
will be frustrated and the burnout rate will increase. As healthcare
providers, we too have to deal with our own depression.
Suicidal patients must learn to forgive themselves. Forgiveness
is huge in treating the suicidal patient. These individuals harbor
a great deal of guilt that increases over time. Some is founded,
and some is not. They have to be able to reach a level of forgiveness.
Alcohol and drugs must not be used. Alcohol and drugs are often
used to self-medicate, but these only temporarily mask the depression
and suicidal tendencies, and actually exacerbate by allowing the
individual to become much more impulsive, increasing the risk of
a successful suicide. Individuals need to understand the symptoms
of depression. There has to be some level of responsibility for
oneself. However that is not going to come initially. These individuals
also have to learn the value of asking for help along the way, that
initially, we have to paddle the canoe of life with someone else,
before we can learn to paddle it by ourselves.
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