Suicidal Thoughts (cont.)

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 provider, 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 such as the following are asked:

• 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 mental illness 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.

• 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.

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