ebook ebooks e-book e-books downloaden bei MyEbooks.ch downloaden

Suicidal Behavior

:	Richard McKeon
:	Suicidal Behavior
:	Hogrefe Publishing
:	9781616763275
:	1
:	CHF 19.80
:

:	Angewandte Psychologie
:	English

:	109
:	Wasserzeichen/DRM
:	PC/MAC/eReader/Tablet
:	PDF

Almost one million people die worldwide by suicide each year, making it one of the leading causes of death throughout the lifespan. Suicide attempts outnumber deaths by suicide by a ratio of at least 25:1, those who attempt suicide are at high risk of later death by suicide, and suicide risk is one of the most frequent reasons for admissions to inpatient psychiatric units. Treatment of those at risk for suicide is thus a pressing priority. Research over the past two decades has led to the development of excellent empirically supported treatment methods. This book aims to increase clinicians' access to empirically supported interventions for suicidal behavior, with the hope that these methods will become the standard in clinical practice.

4 Treatment (S. 39-40)

While there is substantial evidence that pharmacological treatment of disorders that are risk factors for suicide (such as depression) can be effective, pharmacological studies that have targeted suicide directly have had much more equivocal results. In part, this is because clinical trials of medication have historically excluded those at risk for suicide (as have psychotherapy studies). Evidence for the effectiveness of Lithium in preventing suicide is probably stronger than for any other medication (Cipriani, Pretty, Hawton,&, Geddes, 2005).

Meltzer (1999) has examined clozapine versus olanzapine for patients with schizophrenia or schizoaffective disorder who were at high risk for suicide and found that those receiving clozapine were less likely to attempt suicide or be hospitalized for suicide risk. An area of significant controversy recently has been the relationship between the use of SSRIs and suicide risk. While previously the major debate within the field has focused on whether the significantly increased rates of prescription of SSRIs was responsible for a decrease in national suicide rates in various countries around the world (Safer&, Zito, 2007), fears about the potential role of SSRIs in causing suicide erupted in England and the United States. This concern about suicidality as a possible side effect from the use of SSRIs led the Food and Drug Administration to issue a “black box” warning.

The focus of concern was initially on youths, because the evidence of efficacy for treatment of depression among this group was much more equivocal than the evidence among adults, making the risk/benefit ratio more problematic among youths than adults. Following this warning, prescriptions of SSRIs fell significantly. When the youth suicide rate increased in 2004, after almost a decade of decline, some argued that the decrease in use of SSRIs was to blame. While there may be a subgroup of those who take SSRIs who experience an increase in suicidality (Maris, 2007), this does not mean that they are not safe for most patients, particularly those with serious depression. Gibbons, Brown, Hur, Marcus, Bhaumik, and Mann (2007) report that among male veterans treated with SSRIs, suicide attempts decreased.

However, their effectiveness in preventing death by suicide is still uncertain. A review of the literature by Rudd, Joiner, and Rajab (2001), which focused only on nonpharmacologic interventions, revealed only 25 randomized or controlled studies that targeted suicidality. They divided their review into intervention studies and treatment studies. Intervention studies were those that did not provide any kind of psychotherapy or medication treatment.

These studies made changes in either procedures associated with treatment (letters, phone calls), or facilitated access to mental health services and assessed any subsequent reductions in suicide attempts. Of particular note was a study by 4 Treatment While there is substantial evidence that pharmacological treatment of disorders that are risk factors for suicide (such as depression) can be effective, pharmacological studies that have targeted suicide directly have had much more equivocal results. In part, this is because clinical trials of medication have historically excluded those at risk for suicide (as have psychotherapy studies). Evidence for the effectiveness of Lithium in preventing suicide is probably stronger than for any other medication (Cipriani, Pretty, Hawton,&, Geddes, 2005).

	Table of Contents	6
	1 Description	10
	1.1 Terminology	13
	1.2 Definition	14
	1.3 Differential Diagnosis	17
	1.4 Epidemiology	20
	1.5 Course and Prognosis	24
	1.6 Comorbidities	27
	1.7 Assessment Procedures	30
	2 Theories and Models of Suicidal Behavior	35
	2.1 Neuropsychiatric Theories	35
	2.2 Psychological Theories	36
	3 Risk Assessment and Treatment Planning	40
	3.1 Assessing Suicide Risk and Protective Factors	41
	3.2 Estimating Suicide Risk Level	42
	3.3 Resolving Contradictory Risk Factors	43
	3.4 Understanding the Time Dimension of Suicide Risk	44
	3.5 Documenting Suicidal Risk	46
	4 Treatment	48
	4.1 Methods of Treatment	51
	4.2 Crisis Intervention and the Management of Acute Risk	54
	4.3 Safety Planning	61
	4.4 Treatment Techniques	67
	4.5 Mechanisms of Action	78
	4.6 Efficacy and Prognosis	80
	4.7 Variations and Combinations of Methods	80
	4.8 Problems in Carrying Out the Treatments	84
	4.9 Multicultural Issues	87
	5 Case Vignette	89
	Julie	89
	6 Case Example	92
	Intake Evaluation and Treatment Plan	92
	7 Further Reading	96
	8 References	97
	9 Appendices: Tools and Resources	106
	Appendix 1: Outline for Suicide Consultation	107
	Appendix 2: Decision Tree for Intervening with Suicidal Callers	109