A Survey of Clinical Approaches to Suicide Risk Assessment for Patients Intoxicated on Alcohol

Background: Suicidal ideation and alcohol use are common among emergency department patients. It is unclear at what point a suicide risk assessment should occur among patients who present with acute alcohol intoxication.Objective: This study aims to describe practice patterns among expert practition...
Ausführliche Beschreibung

Background: Suicidal ideation and alcohol use are common among emergency department patients. It is unclear at what point a suicide risk assessment should occur among patients who present with acute alcohol intoxication.Objective: This study aims to describe practice patterns among expert practitioners for timing the suicide risk assessment for an intoxicated patient.Methods: An online survey was sent to emergency psychiatrists and behavioral health specialists on 2 national listserves including that of the Academy of Consultation-Liaison Psychiatry's Emergency Psychiatry Special Interest Group.Results: Sixty respondents had a mean of 16 ± 12years (mean ± standard deviation) out of specialty training and had extensive experience and comfort in managing this patient presentation. All respondents were board-certified and most (68%) practiced in academic settings. The most common practice for conducting a safety risk assessment in alcohol-intoxicated patients was to proceed once the patient was clinically sober (58%). Other practices included retesting the patient until a specific blood alcohol concentration was reached (19%) or waiting a certain time after presentation based on the initial blood alcohol concentration (15%). Some (8%) evaluated actively-intoxicated patients for suicide risk. Practice varied slightly based on the location of practice,type of practice, and where the clinician trained.Discussion: Expert clinicians most often describe using a clinical assessment to determine sobriety before completing a suicidal risk assessment, although alternative practices remain common. While advantages and disadvantages vary among different approaches, the quality and evidence base underlying these practices are questioned. Ausführliche Beschreibung