Suicidality at the general hospital - perspective of consultation and liaison psychiatry

Suicidality is a common problem in the general hospital. Patients with comorbid psychiatric disorders or during a psychosocial crisis can develop suicidal ideation during their stay at the general hospital, especially if they suffer from chronic disease. Some somatic disorders, such as cancer, epilepsy, chronic obstructive pulmonary disease, asthma, stroke and chronic pain conditions are associated with an increased risk of suicide. The fact that (1) a major part of patients are treated in the emergency room (ER) after a suicide attempt and (2) a suicide attempt is the strongest predictor for later completed suicide emphasizes the importance of expertise in dealing with suicidal patients in the ER. In order to improve prevention of suicides and suicide attempts within the general hospital and after discharge it is important to educate staff concerning suicidality and enhance detection of suicidal patients. A consultation and liaison psychiatrist should always be involved when there are suicidal patients on wards and in the ER. Assessment of suicidal patients has always to include clear recommendations concerning patient safety and treatment of the underlying condition as well as specific approaches in dealing with suicidal thoughts. Safety measures can include close monitoring, constant observation, restriction to means of suicide, referral to a psychiatric clinic and treatment with sedatives, generally benzodiazepines. Psychiatric disorders are ideally treated according to guidelines and clear recommendations should be given concerning treatment after discharge. Specific psychotherapy for suicidal behaviour possibly reduces the risk of future suicides. A special situation is created by assisted suicides which attribute to suicides in the elderly with a recent increase in the Swiss population. In some cases, undiagnosed depression may contribute to the decision making process, hence, underlining the importance of improved detection and treatment of depression in the elderly.