Depressed and Suicidal Patients in the Emergency Department: An Evidence-Based Approach (Behavioral Health CME) -
Publication Date: May 2019 (Volume 21, Number 5)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 05/01/2022.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Behavioral Health CME credits, subject to your state and institutional approval.
Bernard P. Chang, MD, PhD, FACEP
Assistant Professor of Emergency Medicine, Columbia University Medical Center, New York, NY
Katherine Tezanos, BA
Doctoral Student, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY
Ilana Gratch, BA
Department of Psychiatry, Columbia University Medical Center, New York, NY
Christine Cha, PhD
Assistant Professor, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY
Nicholas Schwartz, MD
Assistant Clinical Professor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Attending Emergency Physician, Maimonides Medical Center, Brooklyn, NY and Elmhurst Hospital Center, Queens, NY
Scott Zeller, MD
Clinical Assistant Professor of Psychiatry, University of California- Riverside, Riverside, CA; Vice-President, Acute Psychiatry, Vituity
With more than 12 million emergency department visits annually related to substance abuse and mental health crises, and approximately 650,000 patients evaluated for suicide attempts, the ED is a critical clinical setting for intervention. This review presents an ED-focused approach to assessing depression and suicide risk, including background information on the classification, epidemiology, and known pathology of depression, as well as the assessment of suicide risk within depression. Best-practice recommendations are made regarding current mental status evaluation and management strategies. Cutting-edge interventions and approaches, including the use of assessment and screening tools, implementation of safety planning, the Zero Suicide model, continuing postdischarge contact, lethal-means counseling, and novel pharmacotherapy approaches are also reviewed.
Excerpt From This Issue
Between managing a septic patient and another with an acute stroke, you note 3 patients waiting to be seen: a 30-year-old apparently healthy man with an upper respiratory infection, an elderly man with a sprained ankle, and a woman needing a medication refill. The young man has a URI, but you also find out that he recently moved to the city and states that he is feeling “overwhelmed” and “sad;” at times thinking of ending his life because he “would be better off dead.” He has never seen a psychiatrist and has never been told by his primary care provider that he has any psychiatric illness. You wonder whether this patient meets criteria for a major depressive episode and whether there are screening tools that could be helpful in deciding whether a psychiatric consultation is indicated...
You enter the next bay to manage the elderly man with the ankle sprain. As you enter, you are met by a woman stating that she is concerned that her father, who twisted his ankle, has been increasingly depressed and has said to her on several occasions, “Maybe I’d be better off dead.” When talking to the patient, he states that he does occasionally have thoughts of wishing he was dead, but he has not had any specific plan. The ankle ends up being less concerning, and you now wonder: “Is this patient safe to go home?” You consider what steps you should take to ensure his safety...
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