Today's psychiatrists practice in an environment that poses difficult challenges. Both treatment time and duration are limited by insurance requirements; many facilities are understaffed; split treatment arrangements are typical; and high-risk, acutely suicidal patients are admitted to inpatient units for short lengths of stay. In addition, law now plays a pervasive role in the practice of psychiatry. The doctor-patient relationship is no longer defined solely by the involved parties. Clinicians must juggle these requirements and limitations while providing the very best care to their patients, especially those at high risk. Preventing Patient Suicide: Clinical Assessment and Management provides the wisdom of Dr. Robert I. Simon's vast clinical experience, combined with the latest insights from the evidence-based psychiatric literature, to offer a cutting-edge survey of suicide prevention and management techniques. The author: Addresses sudden improvement in high-risk suicidal patients, a phenomenon both common and perilous, with techniques for determining whether the improvement is real or feigned. Explores in depth the misuse of suicide risk assessment forms, with emphasis on their inherent limitations. Examines the many entrenched myths and traditions about suicide, exposing them to the critical light of evidence-based medicine, including the concept of "imminent suicide risk" and the myth of "passive suicide ideation". Discusses the continuum of chronic and acute high-risk suicidal patients, the fluidity with which one can become the other, and the difficulty in assessing these patients. Explores how the law and psychiatry interact in frequently occurring clinical situations, and the importance of therapeutic risk management. In addition, the book contains a variety of features that illuminate the subject and enhance the reader's understanding, including: Inclusion of illustrative case studies, combined with commentary on commonly occurring but complex clinical situations. Key points at the end of each chapter that identify critical information. A Suicide Risk Assessment Self-Test, a teaching instrument that consists of fifty questions designed to enhance clinician suicide risk assessment by incorporating evidence-based risk and protective factors. Dr. Simon provides a nuanced, empathic, yet pragmatic perspective on identifying, assessing, and managing the suicidal patient while successfully navigating a complex legal and clinical environment that poses its own risks to the practitioner.
ForewordPrefaceAcknowledgmentsPART I: ASSESSMENTChapter 1. Suicide Risk Assessment: A GATEWAY TO TREATMENT AND MANAGEMENTChapter 2. Enhancing Suicide Risk Assessment Through Evidence-Based PsychiatryChapter 3. Assessing and Enhancing Protective Factors Against Suicide RiskChapter 4. Behavioral Risk Assessment of the Guarded Suicidal PatientChapter 5. Psychiatric Disorders and Suicide RiskChapter 6. Sudden Improvement in Patients at High Risk for Suicide: REAL OR FEIGNED?PART II: MANAGEMENTChapter 7. Patients at Acute and Chronic High Risk for Suicide: CRISIS MANAGEMENTChapter 8. Safety Management of the Patient at Risk for Suicide: COPING WITH UNCERTAINTYChapter 9. Gun Safety Management of Suicidal Patients: A COLLABORATIVE APPROACHChapter 10. Suicide Risk Assessment Forms: CLINICIAN BEWAREChapter 11. Imminent Suicide, Passive Suicidal Ideation, and Other Intractable MythsChapter 12. Quality Assurance Review of Suicide Risk Assessments: REALITY AND REMEDYChapter 13. Therapeutic Risk Management of the Patient at Risk for Suicide: CLINICAL-LEGAL DILEMMASAppendix: Suicide Risk Assessment Self-TestIndex
