Öngür points out how clinicians should also consider that medication side effects can increase the risk of suicide. For example, akathisia, a side effect of antipsychotic medications, can create restlessness that leads to great psychological pain.
In treating suicidality in patients with psychotic disorders, Öngür emphasizes that collaborative care is important. Multidisciplinary teams, including psychiatrists, psychologists, social workers, and other professionals as needed, should be involved in the assessment of patients.
Evidence-based psychotherapy, such as cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), can be effective in addressing psychotic and suicidal symptoms.
Clinicians should also ask patients about their own understanding of their psychosis.
“If you’re not asking about the patient’s understanding of the problems that they’re experiencing, or of suicide, suicidal ideation, and behavior, you may miss important details that are going to be helpful,” he says.
Clinicians should develop a safety plan with patients and families to identify triggers and warning signs and to develop coping strategies. Providers should also make sure that patients know how to access suicide hotlines, crisis centers, and emergency services.
The clinical interview and establishing a rapport with patients are critical to ensuring patients feel heard, validated, and hopeful.
“The interview with a mental health clinician can go a long way to actually restore that hope,” Öngür says.
“You want to be giving people this notion that with good treatment, many people will do well, and you’re not going to stay this way forever. I know you’re feeling very difficult things right now, and it feels intolerable, but there’s light at the end of the tunnel.”
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