Journal Article Annotations
2017, 2nd Quarter
Annotation by Kemuel Philbrick, MD, FAPM
This article provides a practical, well-written summary of the incidence of suicide attempts in multiple psychiatric populations, a brief overview of the neurobiology of suicide, and the mechanics of suicide safety assessment in the ICU. There is also a helpful discussion of staff attitudes toward patients who attempt to end their lives, the range of experience that a patient survivor may encounter, and the risk of further attempts at self-harm in the hospital. The article concludes with consideration of the role of involuntary psychiatric holds in the ICU and a candid review of the limitations of suicide assessments.
This article is not a comprehensive tome on the substantive issues it seeks to cover (the reference list is limited to 31 citations) but neither is it superficial. Rather, it succeeds in confining itself to practical, relevant points of fact and clinical tips. The section on involuntary psychiatric holds includes material that is not necessarily applicable in all 50 states, much less outside the United States, given the variation in relevant laws, so psychiatrists using this article as a teaching resource will need to supplement that section according to local statutes.
With the advent of a new academic year in July, many residents will be venturing into the consultation-liaison arena for the first time in their training. Staff physicians face the annual task of re-teaching the fundamentals of consultative work to a new cohort of learners. This article is a useful ‘go-to summary’ covering the psychiatric assessment of patients in the ICU who have attempted suicide.