Assessment of suicide risk

The risk of suicide is one of the reasons why depression can become an acute medical problem and it must be considered when assessing any patient who is thought to be depressed. The risk is increased in several neurological disorders,25,26 particularly multiple sclerosis, epilepsy, head injury, and spinal cord lesions.

The most important consideration is whether the patient is expressing active suicidal intent, either spontaneously or in response to direct questioning. Box 5.2 shows the profile of demographic factors that increase the risk of suicide, which has emerged from various studies of people who have attempted suicide; a knowledge of these is important when assessing depressed patients.27-29

If the risk of a suicide attempt is considered to be significant, or if there is doubt about this, the neurologist should consult urgently with a psychiatrist colleague who should evaluate the patient as soon as possible. A number of management options, including outpatient or day hospital treatment, are available according to the perceived risk and availability of social support. When the risk is high and the patient has little in the way of support, admission to a psychiatric ward should be advised; in England and Wales this may have to involve applying the Mental Health Act (1983) if the patient cannot be persuaded to accept voluntary admission.

In the case of a patient already in hospital receiving any form of treatment Section 5(2) of the Act enables the patient to be detained if he or she is presenting a danger to him- or herself or others. The application must be made by the doctor in charge of the case, or the nominated deputy. The Section enables the patient to be detained for up to 72 hours during which time an assessment must be made to determine whether the patient should be detained for a further period of assessment and compulsory treatment.

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