Suicidal Ideation

HISTORY:

Suicidal ideation for ‍ ‍hoursdays

Intensity: ‍passive death wish, ‍persistentintermittent

Current plan:

- Mean: ‍ ‍undefined, ‍withwithout access for lethal mean,

- Place: ‍ ‍undefined

- Time: ‍ ‍undefined, ‍withwithout preparations made

Previous suicide attempts: ‍ ‍no

Recent stressors: ‍

Protective factors: ‍none

‍depressed mood

‍hopelessness

‍anxiety

‍worry

‍difficulty concentrating

‍feeling overwhelmed

‍withdrawal from social supports

‍insomnia

‍hypersomnia

‍decreased performance at work/school

‍loss of appetite

‍increased appetite

‍impulsivity

‍risky behavior

‍homicidal ideation

‍substance use

‍hallucinations



Social history:

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonesociallyexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU



Adherence to treatment: ‍goodpoor



EXAM:

Mental Status:

Appearance: ‍well-dressed, ‍well-groomed, ‍goodpoor eye contact, appears ‍age-appropriate

Behavior: ‍cooperativenon-cooperative

Psychomotor activity: ‍normalretardedagitated

Speech: ‍clear, ‍slowrapid, ‍monotonoustalkative

Mood: ‍euthymicdysthymic, ‍anxious, ‍

Affect: ‍euthymic, ‍reactivenon-reactive, ‍full range, ‍appropriate to situation, ‍congruent with mood

Thought process: ‍organizeddisorganized, ‍coherentincoherent, ‍logicalillogical, ‍

Thought content: ‍normalpreoccupationshopelessness, ‍delusions, ‍suicidal ideations, ‍homicidal ideations

Perception: ‍normal, ‍hallucinations, ‍illusions

Cognition: ‍alert, oriented to ‍3 spheres, attention ‍intactdistractible, memory ‍intactimpaired

Judgment: ‍goodmoderatepoor

Insight: ‍goodmoderatepoor into condition

Reliability: ‍goodmoderatepoor



ASSESSMENT:

‍Suicidal ideation ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍LFTs, ‍Creatinine

- Urine toxicology screen

- Safety plan with patient and family

- Removal of access to means

- Regular check-ins by family or friends

- Safety contacts provided

- Avoidance of alcohol and drugs

- ‍Hospitalization

- ‍Antidepressants

- ‍Antipsychotics

- ‍Mood stabilizers

- ‍Anxiolytics

- ‍Psychotherapy

- Psychiatric hold

- Admission to psychiatric unit

- Referral to psychiatrist

- Referral to social worker

- Referral to psychologist

- Referral to crisis team

- Follow-up in ‍ ‍daysweeks

- Return to ER if suicidality worsen or if new symptoms such as psychosis develop