Suicidal ideation/Homicidal ideation

Suicidal Ideation

Risk factors for "successful" suicide includes:

• 1. Age older than 45 years

  2. Alcoholism

  3. Rage and violent behavior

  4. Prior suicide attemtps

  5. Male gender

  6. Experiencing a recent loss or separation

  7. Depression

  8. Unemployment or retirement

  9. Being single, widowed, or divorced

Pt. who have a realistic plan are at greatest risk. Behaviors such as making a will, giving away personal property should be taken seriously. Hospitalization may not be required in patients who agree or "contract" to call for help if their suicidal ideation worsens. If this happens, patient needs a sitter at all times. Involuntary hospitalization is clearly permitted for patients who may pose a danger to themselves. Alcohol addiction should be addressed. Psychotherapy + antidepressant medications (SSRIs), and ECT should be initiated as needed.

Homicidal Ideation

Pt. who are a danger to others have an indication for involuntary hospitalization. Such patients may be restrained, or sedated if necessary. Treatment directed at any underlying disorder should be initiated.