Psychiatric emergencies: A complex case of overdose
and assessment in the emergency department
Recurrent suicidal behaviour, gestures or threats are a core diagnostic feature of borderline
personality disorder (BPD).
It is easy to underestimate the acute risk of suicide in a patient with chronic suicidality, but
there’s a 10% rate of completed suicide in patients diagnosed with BPD.
Suicide risk assessment empathic understanding of the patient’s current presentation
from a biopsychosocial perspective.
First develop sense of respect by finding a comfortable and private environment,
validating the patient’s distress and respecting the decision to come for help.
Intent is a reflection of the intensity of ideation and can be accompanied by a plan
with varying degrees of specificity and lethality. Assess the practicality and level of
implementation of the plan.
o Intent cannot be ignored, even if the plan is unlikely to end in death.
o Detailed plans are a great risk for suicide.
For patients with chronic suicidality, assess the history of attempts. Look for a pattern.
No history of attempts? Look for other potentially dangerous behaviours (e.g.
substance abuse, high-risk sexual behaviours, deliberate self-injurious behaviours).
A therapeutic rapport helps to ensure a thorough risk assessment.
Impulsivity risk factor for suicidal behaviour.
Self-mutilation doubles the risk of suicide.
Childhood abuse increased risk of suicide.
Acute-on-chronic model of suicidality = This
model describes suicidal behaviour as a process in
which chronic risk factors (baseline elevated risk)
and acute stressors together lead to an increased
risk of suicide.
Accurate documentation.
CAIPS = A tool to construct a suicide risk assessment Chronic and Acute factors, Imminent
warning signs, Protective factors, and Summary statement.
and assessment in the emergency department
Recurrent suicidal behaviour, gestures or threats are a core diagnostic feature of borderline
personality disorder (BPD).
It is easy to underestimate the acute risk of suicide in a patient with chronic suicidality, but
there’s a 10% rate of completed suicide in patients diagnosed with BPD.
Suicide risk assessment empathic understanding of the patient’s current presentation
from a biopsychosocial perspective.
First develop sense of respect by finding a comfortable and private environment,
validating the patient’s distress and respecting the decision to come for help.
Intent is a reflection of the intensity of ideation and can be accompanied by a plan
with varying degrees of specificity and lethality. Assess the practicality and level of
implementation of the plan.
o Intent cannot be ignored, even if the plan is unlikely to end in death.
o Detailed plans are a great risk for suicide.
For patients with chronic suicidality, assess the history of attempts. Look for a pattern.
No history of attempts? Look for other potentially dangerous behaviours (e.g.
substance abuse, high-risk sexual behaviours, deliberate self-injurious behaviours).
A therapeutic rapport helps to ensure a thorough risk assessment.
Impulsivity risk factor for suicidal behaviour.
Self-mutilation doubles the risk of suicide.
Childhood abuse increased risk of suicide.
Acute-on-chronic model of suicidality = This
model describes suicidal behaviour as a process in
which chronic risk factors (baseline elevated risk)
and acute stressors together lead to an increased
risk of suicide.
Accurate documentation.
CAIPS = A tool to construct a suicide risk assessment Chronic and Acute factors, Imminent
warning signs, Protective factors, and Summary statement.
