Imboden Christian, Hatzinger Martin
1 Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Dienste Solothurner Spitäler AG, Solothurn.
2 Universität Basel.
Ther Umsch. 2015 Oct;72(10):637-42. doi: 10.1024/0040-5930/a000730.
Suicidality is a common problem in the general hospital. Patients with comorbid psychiatric disorders or during a psychosocial crisis can develop suicidal ideation during their stay at the general hospital, especially if they suffer from chronic disease. Some somatic disorders, such as cancer, epilepsy, chronic obstructive pulmonary disease, asthma, stroke and chronic pain conditions are associated with an increased risk of suicide. The fact that (1) a major part of patients are treated in the emergency room (ER) after a suicide attempt and (2) a suicide attempt is the strongest predictor for later completed suicide emphasizes the importance of expertise in dealing with suicidal patients in the ER. In order to improve prevention of suicides and suicide attempts within the general hospital and after discharge it is important to educate staff concerning suicidality and enhance detection of suicidal patients. A consultation and liaison psychiatrist should always be involved when there are suicidal patients on wards and in the ER. Assessment of suicidal patients has always to include clear recommendations concerning patient safety and treatment of the underlying condition as well as specific approaches in dealing with suicidal thoughts. Safety measures can include close monitoring, constant observation, restriction to means of suicide, referral to a psychiatric clinic and treatment with sedatives, generally benzodiazepines. Psychiatric disorders are ideally treated according to guidelines and clear recommendations should be given concerning treatment after discharge. Specific psychotherapy for suicidal behaviour possibly reduces the risk of future suicides. A special situation is created by assisted suicides which attribute to suicides in the elderly with a recent increase in the Swiss population. In some cases, undiagnosed depression may contribute to the decision making process, hence, underlining the importance of improved detection and treatment of depression in the elderly.
自杀倾向是综合医院中常见的问题。患有合并精神疾病的患者或处于心理社会危机中的患者在综合医院住院期间可能会产生自杀念头，尤其是患有慢性病的患者。一些躯体疾病，如癌症、癫痫、慢性阻塞性肺疾病、哮喘、中风和慢性疼痛状况与自杀风险增加有关。（1）很大一部分患者在自杀未遂后在急诊室接受治疗，以及（2）自杀未遂是日后自杀身亡的最强预测因素，这一事实凸显了急诊室处理自杀患者专业知识的重要性。为了在综合医院内及出院后更好地预防自杀和自杀未遂，对工作人员进行有关自杀倾向的教育并加强对自杀患者的检测非常重要。当病房和急诊室有自杀患者时，应始终有会诊联络精神科医生参与。对自杀患者的评估必须始终包括关于患者安全和基础疾病治疗的明确建议，以及处理自杀念头的具体方法。安全措施可包括密切监测、持续观察、限制自杀手段、转介至精神科诊所以及使用镇静剂（通常为苯二氮䓬类药物）进行治疗。精神疾病理想情况下应按照指南进行治疗，并且应就出院后的治疗给出明确建议。针对自杀行为的特定心理治疗可能会降低未来自杀的风险。协助自杀造成了一种特殊情况，这在瑞士老年人群中导致自杀人数近期有所增加。在某些情况下，未被诊断出的抑郁症可能会影响决策过程，因此强调了改善老年人抑郁症检测和治疗的重要性。
