ALL
PATIENTS SAFE
ADVANCED COURSE
Resources and
References
Resources by
Slide
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Slide |
Resource |
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LEARN Method of Suicide
Prevention |
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Screening for Suicide
Risk |
Updated
Joint Commission Recommendations (December 2018) |
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Review: Depression
Screening in Primary Care Settings |
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Screening Special
Populations: Pediatric |
Severity
Measure for Depression[DR1] ,
Ask
Suicide-Screening Questions (ASQ) |
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Screening Special
Populations: Pregnant & Post-Partum Women |
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Screening Special
Populations: LBG & Transgender |
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Pause & Reflect,
LEARN Steps: Look |
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SAFE-T Assessment |
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SAFE-T Step 3: What is
C-SSRS |
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Plan for Safety |
UW
AIMS Center Patient Safety Plan Template (template is on page 9) |
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Crisis Lines & Other
Supports |
LGB & Transgender and Veteran Hotlines: Confidential, national,
available 24/7/365, and serves all Veterans, Service members, National Guard
and Reserve, and their families and friends. Contact options: ·
Call:
1-800-273-8255 and Press 1 ·
Text:
838255 ·
Chat:
connect at veteranscrisisline.net ·
Support
for deaf and hard of hearing: 1-800-799-4889 Confidential, national,
available 24/7/365, and serves active duty, Guard and reserve members, and
their families and friends. Contact options: ·
Call:
1-800-273-8255 and Press 1 ·
Text:
838255 National, confidential,
available 24/7/365, with 3 contact options: ·
TrevorLifeline, 1-866-488-7386 (phone) ·
TrevorChat
(online IM) ·
TrevorText
(texting) National, staffed
exclusively by trans operators, currently has no middle of night guaranteed
coverage ·
Call:
1-877-565-8860 National, confidential,
limited hours ·
Call:
1-888-234-7243 ·
Email:
help@LGBThotline.org |
|
Tony: Safety Planning |
UW
AIMS Center Patient Safety Plan Template (template is on page 9) |
Additional Resources
National Suicide
Prevention Lifeline: Call 1-800-273-8255 (Available 24 hours every day) https://suicidepreventionlifeline.org/
Forefront: http://www.intheforefront.org/
Safer Homes: http://depts.washington.edu/safehome/
AIMS Center: http://aims.uw.edu/
American
Association of Suicidology: http://suicidology.org/
Beacon Health Call
to Action: http://beaconlens.com/wp-content/uploads/2017/02/Beacon-Suicide-Whitepaper-Final.pdf
Suicide Prevention
Resource Center: http://www.sprc.org/
Zero Suicide: http://zerosuicide.sprc.org/
References
|
Slide Title |
Specific Detail from Source |
Source/Citation |
|
Screening for Suicide
Risk (cont’d) |
USPSTF recommendations
to screen adolescents and adults for depression when appropriate systems are
in place to ensure adequate diagnosis, treatment, and follow-up. |
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Screening for Suicide
Risk (contd) |
2018 Joint Commission
recommendations |
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US Preventive Services
Task Force |
2016 USPSTF
recommendations |
https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/depression-in-adults-screening |
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Review |
Patient Health
Questionnaire-9 (PHQ-9) |
Developed by Drs. Robert
L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues (accessed Aug.
17, 2015). Kroenke K., Spitzer R. L., & Williams J. B. (2003). The
patient health questionnaire-2: Validity of a two-item depression screener.
Medical Care, 41(11), 1284–1292. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/ |
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https://www.phqscreeners.com/images/sites/g/files/g10060481/f/201412/PHQ-9_English.pdf |
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Patient Health
Questionnaire-2 (PHQ-2) |
Kroenke K, et al. The
Patient Health Questionnaire-2: Validity of a Two-Item Depression Screener.
Medical Care 2003, (41) 1284-1294 (accessed Aug. 17, 2015). |
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https://cde.drugabuse.gov/sites/nida_cde/files/PatientHealthQuestionnaire-2_v1.0_2014Jul2.pdf |
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Zero Suicide in Health
and Behavioral Health Care |
Screening for and
assessing suicide risk. (Accessed July 27, 2015). http://zerosuicide.sprc.org/toolkit/identify/screening-and-assessing-suicide-risk
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Screening Special
Populations: Pediatric |
PHQ-A |
Johnson JG, Harris ES,
Spitzer RL, Williams JBW: The Patient Health Questionnaire for Adolescents:
Validation of an instrument for the assessment of mental disorders among
adolescent primary care patients. J Adolescent Health 30:196–204, 2002. |
|
Ask Suicide Screening
Questions |
Horowitz LM, Bridge JA,
Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff
EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask
Suicide-Screening Questions (ASQ). A Brief Instrument for the
Pediatric Emergency Department . Archives
of Pediatrics and Adolescent Medicine. December 2012.
166(12):1170–1176. |
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BHS |
Diamond G, Levy S,
Bevans KB, et al. Development, validation, and utility of Internet-based,
behavioral health screen for adolescents. Pediatrics 2010;126(1):163–70. |
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Screening Special
Populations: Pregnant &
Post-Partum Women |
General reference |
Orsolini, Laura et al. “Suicide
during Perinatal Period: Epidemiology, Risk Factors, and Clinical
Correlates.” Frontiers in Psychiatry 7 (2016): 138. PMC.
Web. 6 Sept. 2017. Or https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981602/ KL Wisner, BL Parry,
CM Piontek. Postpartum Depression. 347(3): N Engl J
Med 194-199. 2002. |
|
Scale |
JL Cox, JM Holden, R Sagovsky. Detection of Postnatal Depression: Development
of the 10-item Edinburgh Postnatal Depression Scale. 150: Br J Psychiatry
782-786. 1987. |
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PHQ-9 and EPDS may be
applied with equal confidence in screening for MDE in the community. |
Santos IS, Tavares BF, Munhoz TN, et al.
Patient Health Questionnaire-9 versus Edinburgh Postnatal Depression Scale in
screening for major depressive episodes: a cross-sectional population-based
study. BMC Research Notes. 2017;10:57. Or |
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Screening Special
Populations: LGB and Transgender |
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Review |
Risk Factors |
https://afsp.org/about-suicide/risk-factors-and-warning-signs/ https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |
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Suicide Assessment in
Medical Setting |
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https://www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf |
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Suicide Assessment in
Medical Setting |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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SAFE-T |
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SAFE-T Assessment |
SAFE-T |
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SAFE-T Assessment |
SAFE-T |
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SAFE-T Step 1: Risk
Factors |
Risk factors |
https://afsp.org/about-suicide/risk-factors-and-warning-signs/ https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html |
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Pediatric-Specific Risk
Factors |
Non-completion of high
school |
Han,
B., Compton, W. M., Eisenberg, D., Milazzo-Sayre, L., McKeon, R., &
Hughes, A. (2016). Prevalence and mental health treatment of suicidal
ideation and behavior among college students aged 18-25 years and their
non-college-attending peers in the United States. The Journal of Clinical
Psychiatry, 77(6), 815-824. |
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30% of youth who die by
suicide are LGBT |
http://www.sprc.org/sites/default/files/migrate/library/SPRC_LGBT_Youth.pdf |
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LGBT youth |
https://medicalxpress.com/news/2010-12-family-lgbt-youth-depression-substance.html |
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Social media and youth
suicide |
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LGBT homelessness |
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Peer
victimization |
JAMA.
2014 Aug 6;312(5):545-6. doi:
10.1001/jama.2014.3212. Peer
victimization, cyberbullying, and suicide risk in children and adolescents. Gini
G, Espelage DL. |
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Suicide
contagion |
Media Contagion and
Suicide Among the Young MADELYN GOULD, PATRICK JAMIESON, DANIEL ROMER
AMERICAN BEHAVIORAL SCIENTIST, Vol. 46 No. 9, May 2003 1269-1284 DOI:
10.1177/0002764202250670 http://www.columbia.edu/itc/hs/medical/bioethics/nyspi/material/MediaContagionAndSuicide.pdf |
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NSSI |
J
Abnorm Psychol. 2013 Feb;122(1):231-7. doi: 10.1037/a0030278. Epub
2012 Oct 15. The relationship between nonsuicidal
self-injury and attempted suicide: converging evidence from four samples. Klonsky
ED1, May AM, Glenn CR. |
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Veteran-Specific Risk
Factors |
Veteran
Content |
http://www.doh.wa.gov/Portals/1/Documents/2300/2016/689NonDOH.pdf |
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Pregnant &
Post-Partum-Specific Risk Factors |
Risk factors |
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981602/ Front Psychiatry. 2016;
7: 138. Published online 2016 Aug 12. doi:
10.3389/fpsyt.2016.00138 PMCID: PMC4981602 Suicide during Perinatal
Period: Epidemiology, Risk Factors, and Clinical Correlates Laura Orsolini,1,2,3,4,*
Alessandro Valchera,2,3 Roberta Vecchiotti,2,3,4 Carmine Tomasetti,3,5,6
Felice Iasevoli,3,6 Michele Fornaro,3,7 Domenico De Berardis,3,8,9 Giampaolo
Perna,10,11 Maurizio Pompili,12 and Cesario Bellantuono13 |
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SAFE-T Step 2: Identify
Protective Factors |
SAFE-T |
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SAFE-T Step 2: Identify
Protective Factors |
Protective factors |
https://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html https://afsp.org/about-suicide/risk-factors-and-warning-signs/ |
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SAFE-T Step 3: Conduct
Suicide Inquiry |
SAFE-T |
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SAFE-T Step 3: What is
C-SSRS |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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SAFE-T Step 3: How to
use C-SSRS |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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How to Step Through the
C-SSRS |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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Scenario #1: Questions 1
& 2 |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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Scenario #1: Question 6 |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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Scenario #2: Questions 1
& 2 |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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Scenario #3: Questions 3
through 5 |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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Scenario #2: Question 6 |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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SAFE-T Step 4: Determine
Level of Risk |
SAFE-T |
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SAFE-T Step 4:
Determining Level of Risk |
SAFE-T |
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Low Risk |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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Moderate Risk |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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High Risk |
Columbia Suicide
Severity Rating Scale (C-SSRS) |
https://www.bcbst.com/docs/providers/Behavioral-health-toolkit/cssrs-lifetime.pdf |
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SAFE-T Step 5: Document |
SAFE-T |
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Breaking Confidentiality
and HIPAA (2 slides) |
Circumstances where it
is allowed to break confidentiality |
https://www.hhs.gov/sites/default/files/ocr/office/lettertonationhcp.pdf |
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HIPPA and Mental Health |
https://www.hhs.gov/hipaa/for-professionals/special-topics/mental-health/index.html |
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Applicable laws |
The HIPAA Privacy Rule
permits a health care provider to disclose protected health information about
an individual, without the individual’s authorization, to another health care
provider for that provider’s treatment of the individual. See 45
CFR 164.506 and the definition of “treatment” at 45
CFR 164.501. https://www.gpo.gov/fdsys/pkg/CFR-2003-title45-vol1/xml/CFR-2003-title45-vol1-sec164-506.xml |
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Pediatric Population:
Confidentiality and State Law |
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18 is the WA State’s age of majority for health RCW
26.28.010 http://app.leg.wa.gov/RCW/default.aspx?cite=26.28.010 Parental participation in treatment decisions RCW
71.34.010
http://app.leg.wa.gov/RCW/default.aspx?cite=71.34.010 Outpatient Mental Health RCW 71.34.530 https://app.leg.wa.gov/rcw/default.aspx?cite=71.34.530 Inpatient Mental Health
RCW 71.34.510 https://app.leg.wa.gov/rcw/default.aspx?cite=71.34.510
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Special Situations:
Intoxicated Patients |
Guidelines for emergency
departments |
In this guide , there is
information on how to manage intoxicated patients: |
|
Guidelines for emergency
departments |
In this article, there
is guidance on how to manage intoxicated patient: http://www.annemergmed.com/article/S0196-0644(15)01264-0/pdf
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Plan for Safety |
Example Guide |
Safety Plan is on page 9:
https://aims.uw.edu/sites/default/files/AIMS_PsychiatricEmergencyManagement_2016.pdf |
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Safety planning quick
guide for clinicians |
http://www.sprc.org/resources-programs/safety-planning-guide-quick-guide-clinicians |
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Safety plan form |
http://www.sprc.org/sites/default/files/Safety_plan_051812%20Final.pdf |
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Wallet card |
http://www.sprc.org/sites/default/files/E1.Phase_3_wallet_card_%204-17-12.pdf |
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Suicide Contracts are
Outdated and Don’t Work |
No evidence that safety contracts are effective, and they can provide a
false sense of security |
J Clin Psychol. 2006
Feb;62(2):243-51. The case against no-suicide contracts: the commitment to
treatment statement as a practice alternative. Rudd MD1, Mandrusiak
M, Joiner Jr TE. |
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Making a Referral for
Hospitalization |
Resources for ED evaluation |
http://www.annemergmed.com/article/S0196-0644(15)01264-0/pdf |
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Example protocols for
involuntary detention (King County, WA) |
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Washington Specific |
https://www.dshs.wa.gov/bha/division-state-hospitals/civil-commitment-inpatient-services |
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Care Transition after
Hospitalization |
Zero Suicide – Structured Follow-up and Monitoring |
https://zerosuicide.edc.org/toolkit/transition#quicktabs-transition=1 |
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Care Transition |
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Caring Contacts
Intervention |
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Suicide Life Threat Behav. 1976 Winter;6(4):223-30. Suicide prevention for high-risk persons who refuse treatment. Motto JA. https://www.ncbi.nlm.nih.gov/pubmed/1023455 Psychiatr Serv. 2001 Jun;52(6):828-33. A randomized controlled trial of postcrisis suicide prevention. Motto JA1, Bostrom AG. https://www.ncbi.nlm.nih.gov/pubmed/11376235 Crisis. 2012 Jan 1;33(1):5-12. doi:
10.1027/0227-5910/a000093. Caring Letters Project: a military suicide-prevention pilot program. Luxton DD1, Kinn JT, June JD,
Pierre LW, Reger MA, Gahm
GA. https://www.ncbi.nlm.nih.gov/pubmed/21940244 Comtois KA, Kerbrat AH, DeCou CR, Atkins DC, Majeres JJ, Baker JC, Ries RK. Effect of Augmenting
Standard Care for Military Personnel With Brief Caring Text Messages for
Suicide Prevention. JAMA Psychiatry, 2019 May 1;76(5):474-483; DOI:
10.1001/jamapsychiatry.2018.4530 |
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How and When to Use
Caring Contacts Intervention |
Sample Letters |
https://zerosuicide.edc.org/resources/nowmattersnow-caring-contacts |
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Review: Antidepressants |
|
N Engl J Med. 2014 Oct 30;371(18):1666-8. doi: 10.1056/NEJMp1408480. Antidepressants' black-box warning--10 years later. Friedman RA |
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Specific Anti-Suicide
Medications |
Patients with mood disorders have a 30-fold greater risk of suicide
compared to the general population. |
Rihmer Z, Kiss K. Bipolar disorders and suicidal behaviour. http://onlinelibrary.wiley.com/doi/10.1034/j.1399-5618.4.s1.3.x/full |
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Compelling evidence provides strong support that lithium has a suicide
protective effect over the long-term course in patients with mood
disorders. |
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Suicide Specific
Psychosocial Interventions |
Evidence-based psychotherapies for suicide prevention |
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Become a Practice
Champion |
General |
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Resources for more structured approach |
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SPRC sample protocol development kit |
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How to Get Started |
Read Zero Suicide introductory materials |
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Complete Zero Suicide Organizational Self Study |
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Practice |
SPRC |
http://www.sprc.org/settings/primary-care http://www.sprc.org/settings/primary-care/toolkit
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AIMS Center |
https://aims.uw.edu/sites/default/files/AIMS_PsychiatricEmergencyManagement_2016.pdf |
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AAFP |
http://www.aafp.org/dam/AAFP/documents/patient_care/nrn/yawnppdfpmiapl.pdf |
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Next Steps for Suicide
Protocol |
Zero Suicide Work Plan |