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lundi 15 janvier 2024

ETUDE RECHERCHE Assessment and management of individuals consulting for a suicidal crisis: A European Delphi method-based consensus guidelines

 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
Vincent Jardon CHU Lille
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

Résumé

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.