Fast Five Quiz: Suicide

Stephen Soreff, MD


March 26, 2019

Warning signs in adolescent patients taking antidepressants that should prompt physician involvement include the following:

  • New or more frequent thoughts of wanting to die

  • Self-destructive behavior

  • Signs of increased anxiety/panic, agitation, aggressiveness, impulsivity, insomnia, or irritability

  • New or more involuntary restlessness (akathisia), such as pacing or fidgeting

  • Extreme degree of elation or energy

  • Fast, driven speech

  • New onset of unrealistic plans or goals

Because "suicide gesture" suggests a lower risk for suicide than may be warranted, "suicide attempt" is a more appropriate term for any deliberately self-harmful behavior or action that had even a small possibility of lethality. Furthermore, "gesture" has a belittling and demeaning connotation.

Any suicide attempt must be thoroughly and immediately treated, once the patient is medically stabilized. The more serious the intent and more lethal the method (eg, use of guns, hanging, jumping from heights), the higher the risk for repeated behavior and the higher the need for inpatient treatment. Intervention should be tailored to the individual adolescent. Those with responsive and supportive families, low probability of acting on suicidal impulses, and responsible observers who can take action if any deterioration occurs may only need outpatient treatment.

Although antisuicide contracts have not proven effective in preventing suicidal behavior among adolescents, the approach may help assess risk. Refusal to agree to a contract that promises to avoid self-harm or to tell a specific person about intent to harm may suggest a high degree of risk and the need for inpatient treatment.

Read more information about suicide prevention here.


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