Therapeutic Risk Management of the Suicidal Patient: Stratifying Risk in Terms of Severity and Temporality
Therapeutic Risk Management of the Suicidal Patient: Stratifying Risk in Terms of Severity and Temporality
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DOI：
10.1097/01.pra.0000442940.46328.63
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发表时间：
2014-01-01
影响因子：
1.9
通讯作者：
Brenner, Lisa A.
中科院分区：
文献类型：
--
作者：
Wortzel, Hal S.;Homaifar, Beeta;Brenner, Lisa A.
本专栏是描述自杀患者治疗风险管理模型的系列文章中的第三篇。在前一栏中，我们描述了用结构化工具增加临床自杀风险评估。在本专栏中，我们描述了临床医生如何使用现有临床数据的总体来提供一个二维风险分层，根据严重程度和时间来确定风险。通过提供两种不同的名称来反映急性和慢性风险的严重程度，以一种更细致的方式来概念化和传达患者的自杀风险，为高风险个体提供必要的细节水平，特别是那些与慢性自杀意念作斗争的人。反映自杀风险的配方需要准确，并有助于良好的临床决策，以最佳地平衡自主、非恶意和有益的原则。根据严重程度和时间对风险进行分层，有助于确定需要非自愿住院的情况，同时也有助于尽量减少不必要的住院。因此，解决急性和慢性自杀风险的二维风险分层是自杀患者治疗风险管理的重要组成部分。
This column is the third in a series describing a model for therapeutic risk management of the suicidal patient. In the preceding column, we described augmenting clinical suicide risk assessment with structured instruments. In this column, we describe how clinicians can use the totality of available clinical data to offer a two-dimensional risk stratification that qualifies risk in terms of both severity and temporality. By offering two separate designations that reflect severity for both acute and chronic risk, conceptualizing and communicating a patient's risk for suicide is accomplished in a more nuanced way, providing the level of detail necessary when working with high risk individuals, especially those struggling with chronic suicidal ideation. Formulations reflecting suicide risk need to be accurate and facilitate good clinical decision-making in order to optimally balance the principles of autonomy, non-maleficence, and beneficence. Stratifying risk in terms of both severity and temporality helps identify situations in which involuntary hospitalization is warranted, while also helping to minimize unnecessary admissions. Hence, two-dimensional risk stratification that addresses both acute and chronic risk for suicide is an essential component of therapeutic risk management of the suicidal patient.