Psych

iatry / A

lcohol a

nd Dru

g

FELLOWSHIP

SAQ P

RINCIP

LES

Suicide risk assessment

SAD PERSONSSex – male 1Age - >55yr or youth 1Depression (PMH) 2Previous attempt 1Ethanol / drugs 1Rational thought loss 2Separated / divorced / widowed 1Organised plan / serious attempt 2No supports 1Sickness (organic) 2

<6 low, 7-8 moderate, >8 high risk

Risk stratification of suicideattempt

IPMO

Intent

Plan

Motivation

Opportunity

Risk:Resue ratioLethality vs publicity

Depressive Illness

IN SAD CAGESInterestSleepAppetiteDepressed moodConcentrationActivityGuiltEnergySuicidal ideation

Major depression >=5/9 for >=2 weeks

Violent Patient

Safety Self, staff, other patients, violent patient

Strategies approach Recognition - PHx, current Hx, drugs and EtOH prevent escalation – see early, show force, set limits, up triage, area

Restraint Verbal, show of force, physical 6 pt arrow, chemical PO IM IV

Safe disposition Inpatient, outpatient

Continued quality improvement CISD Future prevention violence – ED design, control access, education,

undress all patients

EXCLUDE ORGANIC CAUSE!!