Suicidal Thoughts (cont.)

Medical Author:

Roxanne Dryden-Edwards, MD

Roxanne Dryden-Edwards, MD

Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Exams and Tests

The assessment of people with suicidal thoughts is far from an exact science.

• If a person is evaluated by the primary health-care professional, he or she may be instructed to go immediately to the emergency department for further evaluation.



• If evaluated in the emergency department, the emergency doctor may enlist the help of a psychiatrist for more expert diagnosis and treatment.

The assessment, whether in the medical office or emergency department, includes the following parts.

Medical interview: A person who is having thoughts of suicide is interviewed extensively by medical professionals. Questions will look for warning signs that a suicide attempt is imminent, such as the following:

• Have you swallowed any medications or drugs?



• What plan do you have for ending your life?



• What circumstances in your life brought you to the point of suicide?



• Have you ever attempted suicide in the past?



• What is your family history of emotional problems or suicide, if any?



• Have you used alcohol or drugs?



• Have you recently experienced any emotional loss (such as the death of a loved one or a divorce)?



• Do you have any medical illnesses or history of surgery?



• Are you currently taking any herbal, over-the-counter, or prescribed medications?

Mental status: A crucial part of the history is the mental status examination.

• This is a formalized series of questions and commands designed to point toward any psychiatric or neurologic problems, such as depression or schizophrenia.



• The questions may seem silly or insultingly easy, but they are designed to highlight disordered thinking and disorientation that could signal mental illness.

Physical examination: The medical professional performs a head-to-toe physical examination to look for a medical problem, particularly one that could contribute to the person having suicidal thoughts.

• The person's strength, sensation, coordination, reflexes, and ability to walk and balance are checked.



• Depending on the person's age and health status, this may take anywhere from a few minutes to over 20 minutes.



• Any abnormalities may require further evaluation because certain disease states and certain medications can actually cause depression and lead to suicidal thoughts.

Lab tests: The decision to order lab tests is based on the findings of the interview and physical examination.

• No lab test is available for depression, and no lab test is available to tell if someone is serious about committing suicide.



• Any suggestion of medical illness, drug or alcohol intoxication or overdose, or poisoning usually mandates lab tests.



• Blood and/or urine may be checked for drug and alcohol levels.

In some cases, x-ray films, CT scans, or ECGs may be ordered.