Article Dans Une Revue
Spanish Journal of Psychiatry and Mental Health
Année : 2023
Assessment and management of individuals consulting for a suicidal crisis: A European Delphi method-based consensus guidelines
Aiste Lengvenyte, Centre Hospitalier Régional Universitaire [Montpellier],Institut de Génomique Fonctionnelle, Vilnius University [Vilnius]
Lucas Giner, Universidad de Sevilla / University of Sevilla
Emilie Olié, Centre Hospitalier Régional Universitaire [Montpellier], Institut de Génomique Fonctionnelle
Victor Perez Centro de Investigación Biomédica en Red Salud Mental [Madrid]
Pilar Saiz Centro de Investigación Biomédica en Red Salud Mental [Madrid], University of Oviedo
Instituto de Salud Carlos III [Madrid]
Ana Gonzalez Pinto Centro de Investigación Biomédica en Red Salud Mental [Madrid], University of the Basque Country/Euskal Herriko Unibertsitatea, Bioaraba Health Research Institute
Philippe Courtet Centre Hospitalier Régional Universitaire [Montpellier], Institut de Génomique Fonctionnelle
Introduction: Managing patient with suicidal thoughts and
behaviours presents significant challenges due to the scarcity of robust
evidence and clear guidance. This study sought to develop a
comprehensive set of practical guidelines for the assessment and
management of suicidal crises.
Materials and methods: Utilizing the Delphi methodology, 80 suicide
clinician and research experts agreed on a series of recommendations.
The process involved two iterative rounds of surveys to assess agreement
with drafted recommendations, inviting panellists to comment and vote,
culminating in 43 consensus recommendations approved with at least 67%
agreement. These consensus recommendations fall into three main
categories: clinical assessment, immediate care, and long-term
approaches.
Results: The panel formulated 43 recommendations spanning suicidal
crisis recognition to continuous long-term care. These guidelines
underscore systematic proactive suicide risk screening, in-depth medical
and toxicological assessment, and suicide risk appraisal considering
personal, clinical factors and collateral information from family. The
immediate care directives emphasize a secure environment, continuous
risk surveillance, collaborative decision-making, including potential
hospitalization, sensible pharmacological management, safety planning,
and lethal means restriction counselling. Every discharge should be
accompanied by prompt follow-up care incorporating proactive case
management and multi-modal approach involving crisis lines, brief
contact, and psychotherapeutic and pharmacological interventions.
Conclusions: This study generated comprehensive guidelines addressing
care for individuals in suicidal crises, covering pre- to post-discharge
care. These practical recommendations can guide clinicians in managing
patients with suicidal thoughts and behaviours, improve patient safety,
and ultimately contribute to the prevention of future suicidal crises.