背景:由于缺乏有力的证据和明确的指导,管理有自杀念头和行为的患者面临着重大挑战。这项研究旨在为自杀危机的评估和管理制定一套全面的实用指南。
方法:利用德尔菲方法,80名自杀临床医生和研究专家同意了一系列建议。该过程涉及两轮迭代调查,以评估与起草建议的协议,邀请小组成员发表评论和投票,最终得到43项共识建议的批准,至少有67%的同意。这些共识建议分为三大类:临床评估,立即护理,和长期的方法。
结果:该小组制定了43条建议,涵盖了对自杀危机的认识,以持续的长期护理。这些指南强调了系统的主动自杀风险筛查,深入的医学和毒理学评估,考虑到个人的自杀风险评估,来自家庭的临床因素和附带信息。即时护理指令强调安全的环境,持续风险监测,协作决策,包括潜在的住院治疗,明智的药理管理,安全规划,和致命手段限制咨询。每次出院都应伴随着及时的后续护理,包括积极的病例管理和涉及危机线的多模式方法,简短的接触,以及心理治疗和药物干预。
结论:这项研究产生了针对自杀危机中个人护理的全面指南,涵盖出院前和出院后的护理。这些实用的建议可以指导临床医生管理有自杀想法和行为的患者,提高患者安全,并最终有助于预防未来的自杀危机。
BACKGROUND: Managing patient with suicidal thoughts and behaviours presents significant challenges due to the scarcity of robust evidence and clear guidance. This study sought to develop a comprehensive set of practical
guidelines for the assessment and management of suicidal crises.
METHODS: Utilizing the Delphi methodology, 80
suicide clinician and research experts agreed on a series of recommendations. The process involved two iterative rounds of surveys to assess agreement with drafted recommendations, inviting panellists to comment and vote, culminating in 43
consensus recommendations approved with at least 67% agreement. These
consensus recommendations fall into three main categories: clinical assessment, immediate care, and long-term approaches.
RESULTS: The panel formulated 43 recommendations spanning suicidal crisis recognition to continuous long-term care. These
guidelines underscore systematic proactive
suicide risk screening, in-depth medical and toxicological assessment, and suicide risk appraisal considering personal, clinical factors and collateral information from family. The immediate care directives emphasize a secure environment, continuous risk surveillance, collaborative decision-making, including potential hospitalization, sensible pharmacological management, safety planning, and lethal means restriction counselling. Every discharge should be accompanied by prompt follow-up care incorporating proactive case management and multi-modal approach involving crisis lines, brief contact, and psychotherapeutic and pharmacological interventions.
CONCLUSIONS: This study generated comprehensive guidelines addressing care for individuals in suicidal crises, covering pre- to post-discharge care. These practical recommendations can guide clinicians in managing patients with suicidal thoughts and behaviours, improve patient safety, and ultimately contribute to the prevention of future suicidal crises.