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.
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.
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.
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.
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.