A Retrospective Examination of Psychiatric Case Records of Patients who Subsequently Committed Suicide

Flood, R. A.; Seager, C. P.

doi:10.1192/bjp.114.509.443

Cited by 91 publications

(40 citation statements)

References 8 publications

(2 reference statements)

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“…This is well illustrated in the management of psychiatric patients in the ED. Some studies have shown that emergency personnel may actually increase the risk of suicide in depressed patients, 26,27 such iatrogenic contributions to suicide probably having their origin in countertransference. 28 Moral reasoning clearly has no logical validity, depending, as it does, on individual and prevailing societal and cultural values.…”

Section: Reasoning Strategiesmentioning

confidence: 99%

The Cognitive Imperative Thinking about How We Think

Croskerry

2000

Academic Emergency Medicine

199

128

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Abstract. There are three domains of expertise required for consistently effective performance in emergency medicine (EM): procedural, affective, and cognitive. Most of the activity is performed in the cognitive domain. Studies in the cognitive sciences have focused on a number of common and predictable biases in the thinking process, many of which are relevant to the practice of EM. It is important to understand these biases and how they might influence clinical decision-making behavior. Among the specialities, EM provides a unique clinical milieu of inconstancy, uncertainty, variety, and complexity. Injury and illness are seen within narrow time windows, often under pressured ambient conditions. These operating characteristics force practitioners to adopt a distinctive blend of thinking strategies. Principal among them is the use of heuristics, a form of abbreviated thinking that often leads to successful outcomes but that occasionally may result in error. A number of opportunities exist to overcome interdisciplinary, linguistic, and other historical obstacles to develop a sound approach to understanding how we think in EM. This will lead to a better awareness of our cognitive processes, an improved capacity to teach effectively about cognitive strategies, and, ultimately, the minimization or avoidance of clinical error. Key words: emergency medicine; cognition; errors; decision making; heuristics. ACADEMIC EMERGENCY MEDICINE 2000; 7:1223-1231 T HERE are three major skill sets in the performance repertoire of emergency physicians (EPs): procedural, affective, and cognitive.1 It may appear to outside observers, as well as to many within the profession, that emergency medicine (EM) is predominantly action-oriented and that procedural skills are, therefore, the most important of the three. Indeed, during training, a considerable emphasis is directed at the acquisition and retention of skills such as intubation, wound repair, the insertion of chest tubes and central lines, diagnostic peritoneal lavage, lumbar puncture, and cast application. This procedural skill set is tangible, well defined and teachable. While procedural skills are important and integral to an effective performance in the emergency department (ED), they comprise a relatively small part of the overall activity of EPs. Most of our time, in fact, is engaged in cognitive behavior; it is the preponder- ant substance of EM. Surprisingly, it has attracted relatively little attention, perhaps because of an undervalued regard for the importance of exactly how we think. In a recent report, medical educators concluded that EM health care workers were often ''. . . not consciously aware of how they evaluate evidence and cope with decision complexity. '' 2 Proficiency in the cognitive domain, compared with that in procedural skills, is less easily defined, involves a much broader range of possibilities, and would appear to be less easily taught. Kassirer, in 1995, recognized the problem very clearly:Research in the cognitive aspects of clinical problems...

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Section: Reasoning Strategiesmentioning

confidence: 99%

The Cognitive Imperative Thinking about How We Think

Croskerry

2000

Academic Emergency Medicine

199

128

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“…Flood and Seager (1968) reported that of all the psychiatric suicides recorded, more than half occurred within three months of discharge and typically involved shorter hospital stays. A study exploring trends of suicide within 28 days of discharge in Scotland reported that suicide rates in females increased during the period 1968 to 1992, whereas suicide in males decreased .…”

Section: Suicide Post-dischargementioning

confidence: 99%

“…These are similar to recommendations made decades earlier such as services maintaining contact with patients and to inform relatives of their discharge (cf. Flood & Seager, 1968). The research examining the implementation of such strategies has tended to be limited and lacks evidence to suggest they have been successful.…”

Section: Suicide Post-dischargementioning

confidence: 99%

What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

Redding

Maguire

Johnson

et al. 2017

Community Ment Health J

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The first part of this thesis contains a narrative review of the literature relating to how people with mental illness cope with stigma. The majority of the research has focussed on models of stigma, the impact of stigma on individuals and campaigns to combat stigma. There is limited research exploring how people cope with stigma and the effectiveness of these strategies. The review highlights the need for further research in this area to inform interventions.The second part of the thesis contains a qualitative research study, which aimed to provide an understanding of how individuals with a mental illness described their experiences of being discharged from psychiatric inpatient stays. Suicide rates post-discharge remain high despite discharge planning and discharge interventions, yet little is known about why discharge can be so difficult for individuals. Interpretative Phenomenological Analysis (IPA) was used to analyse interviews from eight individuals who had been discharged within the last three years. The analysis highlighted five superordinate themes: the hospital experience, the experience of discharge, the outside world, the journey to health and self-beliefs/identity.The results are discussed in relation to previous findings and implications for future research and clinical practice.

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“…In a study of the records of psychiatric patients who subsequently committed suicide, Flood and Seager (1968) noted that many of these patients could be described as "dependent dissatisfied," and recommended that their recognition could serve as an aid in suicide prevention.…”

Section: Casementioning

confidence: 98%

Patient dissatisfaction and attempted suicide

Richman

Charles

1976

Community Ment Health J

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This paper deals with the presence of suicidal behavior in a mental health clinic and psychiatric emergency room, and its relationships to what has been described in the literature as the "dependent-dissatisfied" personality. Procedures included a suicidal potential scale, projective figure drawings, and a brief interview about past and present suicidal behavior. The scale used significantly differentiated between high and low potentially suicidal groups. The high suicidal group showed a significantly greater dissatisfaction with treatment both past and present. The implications for both evaluation and therapy of suicidal patients are discussed.

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A Retrospective Examination of Psychiatric Case Records of Patients who Subsequently Committed Suicide

Cited by 91 publications

References 8 publications

The Cognitive Imperative Thinking about How We Think

The Cognitive Imperative Thinking about How We Think

What is the Lived Experience of Being Discharged From a Psychiatric Inpatient Stay?

Patient dissatisfaction and attempted suicide

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