Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.
Frequent presenting complaint in the Emergency Department either through attempts at suicide or by expression of thought.
Take events seriously.
Treatment & admission only to be forced in uncooperative patients where the act of self-harm is truly life threatening or the patients are a in danger to themselves or others.
Suicidality scale (“SAD PERSONS HERE”):
1. Sex- male,
2. Age < 25 or >45,
4. Previous attempt,
5. Ethanol & drug abuse,
6. Rational thinking disturbances,
7. Social support lacking,
8. Organized plan,
9. No spouse,
12. Employment, unemployed > 2 years,
13. Recent loss,
14. Early parental loss.
Score 1 point for each item.
· 10 – High risk, Psychiatric review urgently, hospital admission likely,
· 6-10- Moderate nrisk, psychiatric assessment mandatory,
· <6 – Low risk, Psychiatric assessment preferred but discharge & expedient LMO review might be acceptable.
Lethality factor (“IPMO”):
1. Consider sedation with Diazepam IV 10 mg, Midazolam 5-15 IV por Haloperidol 10 mg IV (or 5-10 mg IM as a single dose),
2. Above doses may be repeated after 5 minutes if inadequate response.
3. Droperido 10-20mg IM is a fast acting IM alternative if IV access is not possible,
4. Hospital admission might be required if high risk or lethality factors,
5. May need to recommend for involuntary treatment if non-co-operative.
6. If there is associated underlysing mental illness admission might be required for treatment of this,
7. Liaise with Psychiatric & medical officer.