Preventing Patient Suicide: Clinical Assessment and Management

American Psychiatric Pub
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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.

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About the author

Robert I. Simon, M.D., is Clinical Professor of Psychiatry and Director of the Program in Psychiatry and Law in the Department of Psychiatry at Georgetown University School of Medicine in Washington, D.C. He is also Chairman of the Department of Psychiatry at Suburban Hospital, Johns Hopkins Medicine, in Bethesda, Maryland.

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Additional Information

Publisher
American Psychiatric Pub
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Published on
Aug 24, 2010
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Pages
235
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ISBN
9781585629473
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Language
English
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Genres
Medical / Psychiatry / General
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Content Protection
This content is DRM protected.
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Most people who die by suicide see a clinician prior to taking their lives. Therefore, one of the most difficult determinations clinicians must be able to make is whether any given patient is at risk for suicide in the immediate future. The Suicidal Crisis, Clinical Guide to the Assessment of Imminent Suicide Risk, is the first book written specifically to help clinicians evaluate the risk of such imminent suicidal behavior. The Suicidal Crisis is an essential work for every mental health professional and for anyone who would like to have a framework for understanding suicide. Written by master clinician Dr. Igor Galynker, the book presents methods for a systematic and comprehensive assessment of short-term suicide risk and for conducting risk assessment interviews in different settings. Dr. Galynker describes suicide as an attempt of a vulnerable individual to escape an unbearable life situation, which is perceived as both intolerable and inescapable. What sets the Suicidal Crisis apart from the other books of its kind is its sharp focus on those at the highest risk. It presents a wealth of clinical material within the easy-to-understand and intuitive framework of the Narrative-Crisis model of suicidal behavior. The book contains sixty individual case studies of actual suicidal individuals and their interviews, detailed instructions on how to conduct such interviews, and risk assessment test cases with answer keys. A unique feature of the book, not found in any other book on suicide, is a discussion of how clinicians' emotional responses to acutely suicidal individuals may help identify those at highest risk. In this timely, thorough, and well-written monograph, Dr. Galynker provides a method for understanding the suicidal process and of identifying those at the highest risk for taking their lives. Any clinician who works with suicidal individuals-and anybody who knows someone who has considered suicide-will find the book an essential and illuminating read.
Suicide Risk Management: A Manual for Health Professionals is a short, clearly written book that provides practical guidance on how to manage the suicidal or potentially suicidal patient. Written by two expert teachers, the book has been used in courses for trainee psychiatrists and for health professionals throughout the world. Feedback from participants on these courses has informed revision of the new edition. This book is of interest for all mental health professionals who come into contact with patients who present with suicide potential, i.e. all mental health professionals, as well as general health professionals who are often the first point of contact for a suicidal patient.

The book opens with a review of the epidemiology, risk factors and associated aspects of suicide. It then presents two assessment tools: The Tool for Assessment of Suicide Risk (TASR) provides instruction on how to use it appropriately in the clinic. The Suicide Risk Assessment Guide (SRAG) acts as a self-study program to asess clinical evaluation skills. Both tools were created for use in the authors’ own practice and are now successfully taught to and used by health professionals around the world. Refined through actual experience, these proven tools help assess and evaluate patients with confidence.

Case vignettes allow the reader to practice using the information they have learned from the book.

Throughout the book, bulleted lists, tables and flowcharts effectively describe how to use the many factors to assess the risk of suicide in an individual patient.

The terrorist attacks on the World Trade Center in September 2001 turned PTSD into a household word. But posttraumatic stress disorder has been documented throughout history: For example, as long ago as 1666, Samuel Pepys wrote in his diary that he still had night terrors 6 months after the great fire of London. PTSD, officially recognized as a diagnosis by DSM-III in 1980, is only the most recent term used to describe the suffering of trauma victims.

Few could have foreseen its profound impact on litigation. Often dubbed the "black hole" of litigation -- where allegations are relatively easy to assert but difficult to defend because the symptoms are subjective -- PTSD has deeply influenced civil and criminal law in cases ranging from malpractice and personal injury to sexual harassment and child abuse. It is thus vital for all legal parties involved that forensic examiners perform credible psychiatric and psychological examinations of PTSD claimants.

Intended to add direction and discipline to the forensic assessment of PTSD litigants, this expanded second edition begins with an updated chapter on current and future trends for the role of PTSD in litigation. Chapter 2 notes the increasing evidence that exposure to multiple events not only is more common than previously thought but also increases the risk for development of PTSD following the target event. Chapter 3 details diagnostic criteria and guidelines for the forensic psychiatric examination of the PTSD claimant. Most literature discusses PTSD in adults. Chapter 4 offers a rare perspective on PTSD in children and adolescents, including parental response to the trauma, developmental effects, and delayed onset symptoms. Forensic assessment of PTSD claimants is presented in Chapter 5, followed by new chapters on disability determinants (how PTSD impairs occupational functioning) and PTSD in the workplace, where the causal relationship between employment stress and a resulting mental or emotional disorder must be determined. Chapter 8 covers guidelines for malingering in PTSD, where the claimant may be motivated by financial gain or by a reduced charge resulting from an insanity defense. A new chapter on forensic laboratory testing in PTSD presents the tantalizing potential of psychophysiologic measurement to redeem the PTSD diagnosis from its daunting subjectivity.

This essential collection by 13 U.S. experts sheds important new light on forensic guidelines for effective assessment and diagnosis and determination of disability, serving both plaintiffs and defendants in litigation involving PTSD claims. Mental health and legal professionals, third-party payers, and interested laypersons will welcome this balanced approach to a complex and difficult field.

Patient suicide is an unavoidable occupational hazard of psychiatric practice. Indeed, it is the rare clinician who does not struggle, even agonize, over the complex task of assessing and managing the risk of suicide in patients. Patient suicides account for the greatest number of malpractice suits filed against psychiatrists and for the greatest number of settlements and verdicts covered by professional liability insurers.

In this book, written by a clinician for clinicians, Dr. Simon, an established expert in psychiatry and law, offers A solid, easy-to-understand review of how medical malpractice law applies to patient suicides. He discusses the standards of care physicians must meet, the conditions associated with malpractice liability, and how best to minimize risks of litigation. Extensive references to peer-reviewed literature on suicide and recent malpractice cases, including those triggered by patient suicides, which give insight into the latest developments in both the scientific community and the courts. Much-needed practical advice, including advice on working with suicide risk assessments and suicide prevention contracts, on treating suicidal patients in various settings (outpatient, inpatient, collaborative, and emergency), and on coping with issues arising in the aftermath of a patient's suicide (documentation, confidentiality, and survivor care). Clearly defined risk management guidelines that will help clinicians avoid litigation or establish a sound legal defense if sued for malpractice. Numerous case examples that make the theoretical discussions and clinically based risk management guidelines that follow come alive.

Rich in advice that draws on the author's more than 40 years of clinical experience, this book serves as an essential aid to clinicians.

The release of the Diagnostic and Statistical Manual Version 5 (DSM-5) marked one of the biggest changes to the field of mental health diagnosis in over 20 years. DSM-5 Insanely Simplified provides a summary of key concepts of the new diagnostic schema including a section on the upcoming ICD-10. DSM-5 Insanely Simplified utilizes a variety of devices to help clinicians memorize complex criteria and ideas about the different diagnoses. Cartoons, mnemonic devices, and summary tables allow clinicians and students to quickly grasp and retain broad concepts and subtle nuances related to psychiatric diagnosis. DSM-5 Insanely Simplified fosters quick mastery of the most important concepts introduced in DSM-5 while offering an entirely new way of looking at mental health along a continuum. This new approach avoids simply "labeling" clients by placing them along spectrums that range from normal to problematic symptoms. Mental health professionals as well as laymen interested in a deeper understanding of emotional well-being will appreciate the synthesis of deep psychology and modern approaches to diagnosis.

Steven Buser trained in medicine at Duke University and served 12 years as a physician in the US Air Force. He is a graduate of the two-year Clinical Training Program at the CG Jung Institute of Chicago and is a co-founder of the Asheville Jung Center. In addition to a busy psychiatric private practice he serves as Publisher for Chiron Publications. He is active in the community and strives to integrate faith and spirituality into psychotherapy. He resides in the mountains in Asheville, NC with his wife and two children.

Len Cruz is the Editor-in-Chief of Chiron Publications, a book publishing company specializing in psychology, mythology, religion, and culture and a co-founder of the Asheville Jung Center. He is a psychiatrist who resides in Western North Carolina.

Luke Sloan was a 5th grade student in Asheville, NC when he completed the illustrations for this book. When he's not drawing, Luke enjoys playing soccer, reading books, snow-skiing, and just plain having fun!
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