Nervenheilkunde 2024; 43(03): 109-114
DOI: 10.1055/a-2234-1111
Übersichtsarbeit

Suiziddrohungen bei Entlassung aus stationär-psychiatrischer Behandlung

Ein Verstehens- und InterventionsvorschlagSuicide threats on discharge from inpatient psychiatric treatmentA proposal for understanding and intervention
Christoph Koban
1   Praxis für Psychotherapie, Essen
,
Tobias Teismann
2   Forschungs- und Behandlungszentrum für Psychische Gesundheit, Ruhr-Universität Bochum
› Author Affiliations

ZUSAMMENFASSUNG

Suiziddrohungen vor einer geplanten Entlassung stellen Behandler im stationären Setting vor erhebliche Schwierigkeiten; insbesondere, da sich nicht sicher differenzieren lässt zwischen sogenannten Suizidgesten und genuiner Suizidalität. Es empfiehlt sich, frühzeitig während eines stationären Aufenthalts suizidales Erleben und Verhalten explizit zum Thema zu machen. Die therapeutische Auseinandersetzung sollte dabei auf einem fundierten Fallkonzept aufbauen und muss die motivationale Ausgangslage von Patienten berücksichtigen. Motivations- und beziehungsfördernde Therapiestrategien sind veränderungsorientierten Therapieinterventionen dabei immer voranzustellen. Strukturierte Therapieprogramme während und nach dem stationären Aufenthalt können für die weitergehende Aufarbeitung genutzt werden.

ABSTRACT

Suicide threats before discharge pose considerable difficulties for treatment providers in the inpatient setting; especially since it is not possible to reliably differentiate between suicide gestures and genuine suicidality. It is advisable to explicitly focus on suicidal ideation and behavior at an early stage during the inpatient stay. Treatment should be based on a well-founded case concept and must consider the patient’s motivational situation. Motivational and relationship-promoting therapy strategies should always precede change-oriented therapy interventions. Structured suicide-specific therapy programs during and after the inpatient stay should be used for further treatment.



Publication History

Article published online:
13 March 2024

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  • Literatur

  • 1 Chung DT, Ryan CJ, Hadzi-Pavlovic D. et al Suicide rates after discharge from psychiatric facilities: a systematic review and meta-analysis. JAMA Psychiatry 2017; 74: 694-702 DOI: 10.1001/jamapsychiatry.2017.1044.
  • 2 Chung D, Hadzi-Pavlovic D, Wang M. et al Meta-analysis of suicide rates in the first week and the first month after psychiatric hospitalisation. BMJ open 2019; 09: e023883 DOI: 10.1136/bmjopen-2018-023883.
  • 3 Madsen T, Erlangsen A, Hjorthøj C. et al High suicide rates during psychiatric inpatient stay and shortly after discharge. Acta Psychiatr Scand 2020; 142: 355-365 DOI: 10.1111/acps.13221.
  • 4 Large M, Sharma S, Cannon E, Ryan C. et al Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Aust NZJ Psychiatry 2011; 45: 619-628 DOI: 10.3109/00048674.2011.590465.
  • 5 Hawton K, Lascelles K, Pitman A. et al Assessment of suicide risk in mental health practice: shifting from prediction to therapeutic assessment, formulation, and risk management. Lancet Psychiatry 2022; 09: 922-928 DOI: 10.1016/S2215-0366(22)00232-2.
  • 6 Teismann T, Hilbert K, Forkmann T. Prädiktion suizidalen Verhaltens: Von der klinischen Urteilsbildung zur künstlichen Intelligenz. Nervenheilkunde 2022; 41: 253-257
  • 7 Woodford R, Spittal MJ, Milner A. et al Accuracy of clinician predictions of future self-harm: a systematic review and meta-analysis of predictive studies. Suicide Life-Threat 2019; 49: 23-40 DOI: 10.1111/sltb.12395.
  • 8 BÄK, KBV, AWMF Nationale VersorgungsLeitlinie Unipolare Depression; 2022. https://www.awmf.org/leitlinien/detail/ll/nvl-005.html Stand : 27.12.2023
  • 9 Nock MK, Holmberg EB, Photos VL. et al Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychol Assess 2007; 19: 309-317
  • 10 Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol 2006; 115: 616-623 DOI: 10.1037/0021-843X.115.3.616.
  • 11 Robinson K, Scharinger C, Brown RC. et al Communicating distress: suicide threats/gestures among clinical and community youth. Eur Child Adolesc Psychiatry 2023; 32: 1497-1506 DOI: 10.1007/s00787-022-01960-5.
  • 12 Huckins-Noss AM, Stubbing J, Fox KR. et al The classification of suicide gestures: Examining the validity, measurement, and level of intent of a controversial construct. Suicide Life-Threat 2023; 53: 188-197 DOI: 10.1111/sltb.12930.
  • 13 Paris J.. Half in love with death. Managing the chronic suicidal patient. London: Routledge; 2007
  • 14 Comtois KA, Hendricks KE, DeCou CR. et al Reducing short term suicide risk after hospitalization: A randomized controlled trial of the Collaborative Assessment and Management of Suicidality. J Affect Disord 2023; 320: 656-666 DOI: 10.1016/j.jad.2022.09.042.
  • 15 Ghahramanlou-Holloway M, LaCroix JM, Perera KU. et al Inpatient psychiatric care following a suicide-related hospitalization: A pilot trial of Post-Admission Cognitive Therapy in a military medical center. Gen Hosp Psychiatry 2020; 63: 46-53 DOI: 10.1016/j.genhosppsych.2018.11.006.
  • 16 Santel M, Neuner F, Berg M. et al The Collaborative Assessment and Management of Suicidality compared to enhanced treatment as usual for inpatients who are suicidal: A randomized controlled trial. Front Psychiatry 2023; 14: 1038302 DOI: 10.3389/fpsyt.2023.1038302.
  • 17 Dimeff LA, Jobes DA, Koerner K. et al Using a tablet-based app to deliver evidence-based practices for suicidal patients in the emergency department: pilot randomized controlled trial. JMIR Ment Health 2021; 08: e23022 DOI: 10.2196/23022.
  • 18 Dimeff LA, Jobes DA, Tyndal T. et al Using the delphi method for determining key performance elements for delivery of optimal suicide-specific interventions in emergency departments. Arch Suicide Res 2023; 27: 246-260 DOI: 10.1080/13811118.2021.1984347.
  • 19 Gysin-Maillart A. Kurztherapie nach Suizidversuch. ASSIP. Göttingen: Hogrefe; 2021
  • 20 Bryan CJ, Rudd MD. Brief cognitive-behavioral therapy for suicide prevention. New York: Guilford Press; 2018
  • 21 Koban C, Teismann T. Psychotherapie mit suizidalen Patienten: Verstehen und Verbessern der motivationalen Ausgangslage. Psychotherapie Aktuell 2017; 09: 24-31
  • 22 Caspar F. Beziehungen und Probleme verstehen. Göttingen: Hogrefe; 2018
  • 23 Jobes D. Managing suicide risk. New York: Guilford Press; 2023
  • 24 Teismann T, Friedrich S. Therapie-Tools: Suizidalität und Krisenintervention. Weinheim: Beltz; 2022
  • 25 Britton P, Patrick H, Wenzel A. et al Integrating motivational interviewing and self-determination theory with cognitive behavioral therapy to prevent suicide. Cogn Behav Prac 2011; 18: 16-27 DOI: 10.1016/j.cbpra.2009.06.004.
  • 26 Teismann T, Koban C. Chronische Suizidgedanken: ein Behandlungsvorschlag. Verhaltenstherapie 2022; 32: 222-229
  • 27 Miller WR, Rollnick S. Motivierende Gesprächsführung. Freiburg: Lambertus; 2015
  • 28 Teismann T, Koban C, Illes F. et al Psychotherapie suizidaler Patienten. Göttingen, Hogrefe 2016
  • 29 Teismann T, Düwel H, Eidt L. et al Psychotherapists’ knowledge of guideline recommendations for the treatment of depressed suicidal patients. Front Psychiatry 2022; 13: 873127
  • 30 Tay JL, Li Z. Brief contact interventions to reduce suicide among discharged patients with mental health disorders. A meta-analysis of RCTs. Suicide Life-Threat 2022; 52: 1074-1095 DOI: 10.1111/sltb.12903.
  • 31 Miller IW, Gaudiano BA, Weinstock LM. Coping Long Term with Active Suicide Program. Oxford: University Press; 2022
  • 32 Miller IW, Gaudiano BA, Weinstock LM. The Coping Long Term with Active Suicide Program: Description and pilot data. Suicide Life-Threat 2016; 46: 752-761 DOI: 10.1111/sltb.12247.
  • 33 Miller IW, Camargo Jr CA, Arias SA. et al Suicide prevention in an emergency department population: The ED-SAFE Study. JAMA Psychiatry 2017; 74: 563-570 DOI: 10.1001/jamapsychiatry.2017.0678.