The Harvard Medical School Guide to Suicide Assessment and Intervention

This vital resource--edited by Harvard Medical School's DouglasJacobs, a nationally recognized expert on suicide anddepression--is the definitive guide for helping mental healthprofessionals determine the risk for suicide and appropriateinterventions for suicidal or at-risk patients. Created primarilyfor mental health clinicians (with several chapters directed towardprimary care physicians), the book is a hands-on guide for thosewho are often the first line of defense for assessing if a patientor client is suicidal.

Comprehensive in scope, the book offers a wealth of informationabout such useful topics as inpatient and outpatient issues,psychopharmacology, and advice about working with specialpopulations. Most importantly, the book's contributors detaileffective techniques for intervention and offer a model of suicideassessment that focuses on predisposing conditions, potentiatingconditions, and specific suicide inquiries. As a special feature,the book also includes a helpful section on contracts--agreementsmade with the patient not to harm themselves--and useful factsabout the subsequent liability issues. In addition, there is acompelling analysis of the controversial issues surroundingassisted suicide as well as an honest personal account ofsuicidality from a professional who has experienced it for herself. Foreword, Joseph T. Coyle, M.D.

Preface, Douglas G. Jacobs, M.D.

ASSESSMENT.

Suicide Assessment: An Overview and Recommended Protocol (D.Jacobs, et al.).

Epidemiology of Suicide (E. Moscicki).

A Community Psychiatry Approach to Preventing Suicide (R. Dorwart& M. Ostacher).

The Psychodynamic Understanding of Suicide (J. Maltsberger).

Perturbation and Lethality: A Psychological Approach to Assessmentand Intervention (E. Shneidman).

The Neurobiology of Suicidal Behavior (J. Mann & V.Arango).

Profiles of Completed Suicides (J. Fawcett).

Self-Mutilation (A. Favazza).

Standard Protocol for Assessing and Treating Suicidal Behaviors forPatients in Treatment (M. Linehan).

Murder Suicide: Phenomenology and Clinical Implications (M. Nock& P. Marzuk).

Excerpts from Academic Conference and Recognition of Suicidal RisksThrough the Psychologic Examination (L. Havens).

Critical Points in the Assessment and Management of Suicide Risk(J. Motto).

Can Suicide Ever Be Eradicated?: A Personal Journey (P.Cantor).

INTERVENTION.

Suicide and Manic-Depressive Illness: An Overview and PersonalAccount (K. Jamison).

Lifetime Risk of Suicide in Major Affective Disorders (D. Clark& A. Goebel-Gabbri).

Suicide and Schizophrenia (M. Tsuang, et al.).

Substance Abuse and Suicide (R. Weiss & M. Hufford).

Borderline Personality Disorder (T. Davis, et al.).

Trauma and Suicide (J. Chu).

Antisuicidal Effect of Lithium Treatment in Major Mood Disorders(R. Baldessarini & L. Tondo).

Treatment of the Suicidal Patient with Psychotropic Drugs and ECT(C. Salzman).

The Inpatient Management of Suicidality (G. Jacobson).

ECT and Suicide (E. Metzger).

SPECIAL ISSUES.

Suicide in Children and Adolescents (S. Goldman & W.Beardslee).

Suicide in the Elderly (D. Steffens & D. Blazer).

Suicide-Prevention Contracts: Advantages, Disadvantages, and andAlternative Approach (M. Miller).

Guidlines for Conducting a Suicide Review (S. Stelovich).

Medical Settings and Suicide (M. Kelly, et al.).

Suicide Assessment in the Primary Care Setting (M. Miller & R.Paulsen).

Suicide, Assisted Suicide, and Euthanasia (H. Hendin).

Liability Issues and Liability Prevention in Suicide (T.Gutheil).

Appendix A: Guidelines for Identification, Assessment, andTreatment for Suicidality.

Appendix B: Risk Management Foundation of the Harvard MedicalInstitutions.

References.

About the Authors.

Name Index.

Subject Index. "The Harvard Guide puts the best and the brightest of consultingsuicidologists on the practicing clinician's bookshelf, . . . .must-read." (Lanny Berman, executive director, American Associationof Suicidology)

"[This book] presents the most up-to-date material and combinesthis framework with practical suggestions for the clinician. Thisis sure to become a classic." (Alan F. Schatzberg, Kenneth T.Norris, Jr. Professor and chairman, Department of Psychiatry andBehavioral Sciences, Stanford University School of Medicine)

"The threat of suicide is riveting; its reality is devastating; itis our life-or-death clinical challenge. This volume is thesingularly comprehensive, authoritative, definitive, and usefultext on suicide. We are now strengthened for our work." (Jerrold F.Rosenbaum, Massachusetts General Hospital, Harvard MedicalSchool)

"For the clinician needing help with a suicidal patient?this isyour book. For the student or researcher seeking the state of theart on suicide?this is your book." (Robert M. A. Hirschfeld, TitusHarris Distinguished Professor and chair, Department of Psychiatryand Behavioral Sciences, University of Texas Medical Branch atGalveston)

DOUGLAS G. JACOBS M.D., is associate clinical professor of psychiatry at the Harvard Medical School and executive director of the nonprofit National Mental Illness Screening Project. He has edited two textbooks on suicide, Suicide: Understanding and Responding and Suicide and Clinical Practice.

More than 30,000 deaths in the United States each year?more than 80 per day?are a result of suicide. Suicide is the primary cause of early death among psychiatric patients and an issue in one quarter of all psychiatric malpractice lawsuits.The fundamental question is, How can clinicians identify patients who may be at risk for suicide and take the necessary steps to reduce that risk?This essential resource?edited by Douglas G. Jacobs, Harvard Medical School's nationally recognized expert on suicide and depression?is a compendium of the most current research and authoritative thought on the topic of suicide. Each of the volume's forty-eight contributors is an expert on an aspect of suicide assessment and intervention. The breadth of knowledge offered in this handbook speaks to the fact that suicide is a complex, multidimensional clinical problem that requires a wide range of methods for effective assessment and treatment.This hands-on guide is written for those who have the common yet complex task of assessing suicidality in a patient or client?psychiatrists, primary care physicians, school counselors, psychologists, psychotherapists, and other mental health professionals. The book helps professionals determine the risk level for suicidal or at-risk patients and recommends a suicide assessment protocol that can be effectively incorporated into clinical practice. The authors also provide guidelines for intervening when a person is at risk for harming himself or herself.Comprehensive in scope, the book offers a wealth of information and practical advice on specific topics, including working with special at-risk populations such as adolescents, the physically ill, and those with major mental illness, alcoholism, or borderline personality disorder. The book also addresses the somatic treatment of the suicidal patient, including important new findings about the possible antisuicidal effect of lithium. In addition, the guide contains important cautions rega

More than 30,000 deaths in the United States each year—more than 80 per day—are a result of suicide. Suicide is the primary cause of early death among psychiatric patients and an issue in one quarter of all psychiatric malpractice lawsuits.

The fundamental question is, How can clinicians identify patients who may be at risk for suicide and take the necessary steps to reduce that risk?

This essential resource, edited by Douglas G. Jacobs, Harvard Medical School's nationally recognized expert on suicide and depression is a compendium of the most current research and authoritative thought on the topic of suicide. Each of the volume's forty-eight contributors is an expert on an aspect of suicide assessment and intervention. The breadth of knowledge offered in this handbook speaks to the fact that suicide is a complex, multidimensional clinical problem that requires a wide range of methods for effective assessment and treatment.

This hands-on guide is written for those who have the common yet complex task of assessing suicidality in a patient or client-psychiatrists, primary care physicians, school counselors, psychologists, psychotherapists, and other mental health professionals. The book helps professionals determine the risk level for suicidal or at-risk patients and recommends a suicide assessment protocol that can be effectively incorporated into clinical practice. The authors also provide guidelines for intervening when a person is at risk for harming himself or herself.
Comprehensive in scope, the book offers a wealth of information and practical advice on specific topics, including working with special at-risk populations such as adolescents, the physically ill, and those with major mental illness, alcoholism, or borderline personality disorder. The book also addresses the somatic treatment of the suicidal patient, including important new findings about the possible antisuicidal effect of lithium. In addition, the guide contains important cautions regarding suicide contracts and offers timely information about liability prevention from an authority in the field of suicide and malpractice lawsuits. On a personal note, one chapter is an honest and intimate account from a professional who has attempted suicide herself.

The Harvard Medical School Guide to Suicide Assessment and Intervention is the definitive guide for assisting clinicians in their crucial and continual task determining the risk for and intervening against suicide.

A Handbook for Assessing and Treating the Suicidal Patient

Is your patient suicidal?

Knowing when a person is suicidal and intervening to reduce the risk of his or her death is one of the most stressful, difficult, yet vitally important tasks faced by counselors and health care providers everywhere.

Written by the top experts in the field, this definitive guide is the first in a new series of books developed in cooperation with the Department of Psychiatry at Harvard Medical School. The Harvard Medical School Guide to Suicide Assessment and Intervention is an essential reference that provides clinicians with information and strategies for appropriate responses to patients or clients who are at risk for suicide.

"The Harvard Guide puts the best and the brightest of consulting suicidologists on the practicing clinician?s bookshelf, offering an invaluable resource for understanding and treating the at-risk suicidal patient. Our patients will benefit greatly from the insights and directives in the book. I urge caregivers to make this a must read."
—Lanny Berman, executive director, American Association of Suicidology

"The threat of suicide is riveting; its reality is devastating; it is our life-or-death clinical challenge. This volume is the singularly comprehensive, authoritative, definitive, and useful text on suicide. We are now strengthened for our work."
—Jerrold F. Rosenbaum, Massachusetts General Hospital, Harvard Medical School

"[This book] presents the most up-to-date material and combines this framework with practical suggestions for the clinician. This is sure to become a classic."
—Alan F. Schatzberg, Kenneth T. Norris, Jr. Professor and chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine

"For the clinician needing help with a suicidal patient?this is your book. For the student or researcher seeking the state of the art on suicide?this is your book."
—Robert M. A. Hirschfeld, Titus Harris Distinguished Professor and chair, Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston