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[青少年自杀倾向的评估与治疗:当前指南的最重要建议]

[Assessment and therapy of suicidality in adolescence: the most important recommendations of the current guideline].

作者信息

Becker Katja, Adam Hubertus, In-Albon Tina, Kaess Michael, Kapusta Nestor, Plener Paul L

机构信息

1 Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Marburg und Philipps-Universität Marburg.

2 Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Martin Gropius Krankenhaus, Eberswalde.

出版信息

Z Kinder Jugendpsychiatr Psychother. 2017 Nov;45(6):485-497. doi: 10.1024/1422-4917/a000516. Epub 2017 Mar 10.

Abstract

Due to the clinical relevance of suicidal risks, suicide attempts, and suicides in adolescence consensus-based guidelines with clinical recommendations were updated and summarized in this article. It should be considered that each indication has to be taken serious. Suicidality is an essential component of the psychopathological report and should be explored for the short- and long term risk. The clinical assessment of the acute suicidality results from a trustful anamnestic conversation, assessment of risk factors, mental disorders, and the use of alcohol and drugs. Acute suicidality is an indication for an inpatient treatment that for the protection of the patient has to be implemented also against his will. An adequate documentation is inevitable. After a suicide attempt, in addition to the initial medical treatment it has to be paid attention that the patient cannot harm himself any further and a rapid consultation in the responsible clinic takes place. First therapeutic goal is the reduction of suicidality and if necessary the re-achievement of the ability to negotiate a non-suicide agreement. For recurrent suicide thoughts an emergency plan has to be created. In addition to offer conversations, for a further relief a temporary sedated psychopharmacology can be necessary. In case of a suicide in a clinic, recommendations should be present that regulates responsibilities and procedures. Effective prevention methods are multiplier training, public education, restricted access to methods, and complying with media guidelines.

摘要

鉴于自杀风险、自杀未遂及青少年自杀在临床上的相关性,本文对基于共识的临床建议指南进行了更新和总结。应认识到,每种迹象都必须予以重视。自杀倾向是心理病理学报告的重要组成部分,应探究其短期和长期风险。急性自杀倾向的临床评估源于可信的问诊、风险因素评估、精神障碍评估以及酒精和药物使用情况评估。急性自杀倾向是住院治疗的指征,为保护患者,即便违背其意愿也必须实施。充分记录是必不可少的。自杀未遂后,除了进行初始治疗外,还必须注意患者不能再伤害自己,并要在负责的诊所进行快速会诊。首要治疗目标是降低自杀倾向,如有必要,重新达成不自杀协议的能力。对于反复出现的自杀念头,必须制定应急预案。除了提供谈话外,为进一步缓解症状,可能需要进行临时镇静性心理药理学治疗。如果诊所发生自杀事件,应制定规范责任和程序的建议。有效的预防方法包括多重培训、公众教育、限制获取自杀手段以及遵守媒体指南。

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