Accorsi Tarso Augusto Duenhas, De Amicis Lima Karine, Köhler Karen Francine, Cordioli Eduardo, Pedrotti Carlos Henrique Sartorato
Hospital Israelita Albert Einstein, Secretaria da Unidade de Telemedicina, Av. Albert Einstein, 627. Bloco B, 2° Andar, Sao Paulo, 05652-900, Brazil.
Int J Emerg Med. 2023 Nov 13;16(1):84. doi: 10.1186/s12245-023-00557-2.
Nowadays, we find ourselves in very unexpected and challenging circumstances facing the COVID-19 pandemic. The impact of the new coronavirus pandemic probably affected everyone's mental health, and people with pre-existing mental disorders may have an aggravated disease condition, leading to a suicide attempt. Pandemic also increased the use of direct-to-consumer telemedicine (TM) exponentially, and consequently, it was expected that cases of attempted suicide could be evaluated remotely. Some TM centers have adapted safety protocols from psychiatric guidelines for managing these patients. However, there is a lack of evidence of the effectiveness of follow-up by TM for patients at high risk for suicide, and there is no consensus on what action should be taken vis-à-vis the patient who requests immediate help remotely.
Here, we reported a case of a TM evaluation of a patient's suicidal ideation in a direct-to-consumer telemedicine emergency center, describing the conduct taken in the face of this situation. We also discuss the importance of planning the emergency telemedicine center for situations of risk of suicide.
Telemedicine centers should be prepared for direct consumer assessment of suicidal ideation. Current management suggestions include recognizing the risk profile through institutional training and software skills and immediate referral for face-to-face assessment, encouraging continuous monitoring until the admission and active recruitment of family members or closest friends.
如今，我们发现自己身处应对新冠疫情这一极其意外且充满挑战的环境中。新型冠状病毒大流行的影响可能波及了每个人的心理健康，而患有既往精神障碍的人群病情可能会加重，进而导致自杀企图。大流行还使直接面向消费者的远程医疗（TM）的使用呈指数级增长，因此，预计自杀未遂病例可通过远程方式进行评估。一些远程医疗中心已采用精神科指南中的安全协议来管理这些患者。然而，缺乏证据表明远程医疗对自杀高危患者随访的有效性，对于远程请求紧急帮助的患者应采取何种行动也未达成共识。
在此，我们报告了一例在直接面向消费者的远程医疗急救中心对患者自杀意念进行远程医疗评估的病例，描述了面对这种情况所采取的行动。我们还讨论了为自杀风险情况规划紧急远程医疗中心的重要性。
远程医疗中心应做好准备，以便对自杀意念进行直接面向消费者的评估。当前的管理建议包括通过机构培训和软件技能识别风险状况，并立即转诊进行面对面评估，鼓励持续监测直至入院，并积极招募家庭成员或最亲密的朋友。
