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Clinical assessment and crisis intervention for the suicidal bipolar disorder patient.

机译：自杀性双相情感障碍患者的临床评估和危机干预。

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Suicidal behaviour is common in people suffering with bipolar disorder, and suicide is a leading cause of death in this group. Our aim in this review is to provide an overview of key assessment and management strategies, highlight research findings relevant to suicide prevention, and identify important areas for future research.We reviewed the published literature regarding the risk factors for and management of suicidal behaviour in individuals with bipolar disorder using the Pubmed and PsychINFO databases. Where available, we focused our search on systematic reviews.Suicide is usually associated with a depressive phase, although mixed affective states also convey increased risk. All individuals with bipolar disorder should have an up-to-date crisis management plan which outlines the action to be taken should suicidal behaviour emerge. Timely clinical assessment is essential in ensuring that those at high risk are identified. This should include mental state examination, consideration of risk factors, and evaluation of issues such as access to means, preparatory acts before suicide, and also protective factors. While pharmacological approaches are the mainstay of management, less specific measures, such as the removal of access to means, are also important in ensuring safety in the acute situation. Intensifying the clinical support of both patients and relatives, and the sharing of risk information with other health agencies are essential in management. Specific psychological treatments are likely to be helpful in preventing crises, although the evidence base is limited.The aetiology of suicidal behaviour in bipolar disorder is multifactorial and requires proactive crisis planning and management. A range of issues need to be addressed in the assessment of at-risk patients. Determining the efficacy of interventions specific to reducing suicidality in bipolar disorder should be a research priority.
机译：自杀行为在双相情感障碍患者中很常见，自杀是该人群死亡的主要原因。我们在这篇综述中的目的是概述主要的评估和管理策略，突出显示与自杀预防相关的研究结果并确定未来的重要研究领域。我们回顾了有关自杀行为的危险因素和管理的文献使用Pubmed和PsychINFO数据库在双相情感障碍患者中进行研究。在可能的情况下，我们将搜索的重点放在系统评价上。自杀通常与抑郁症有关，尽管混合的情感状态也会增加患病的风险。所有患有躁郁症的人都应制定最新的危机管理计划，其中概述了自杀行为出现时应采取的措施。及时的临床评估对于确保识别高危人群至关重要。这应该包括精神状态检查，风险因素的考虑以及对诸如获取手段，自杀前的准备行为以及保护性因素等问题的评估。虽然药理学方法是管理的主要手段，但在确保紧急情况下的安全性方面，较不具体的措施（例如取消获取药物的途径）也很重要。加强患者和亲属的临床支持，以及与其他卫生机构共享风险信息对于管理至关重要。尽管证据基础有限，但特定的心理治疗可能有助于预防危机。双相情感障碍中自杀行为的病因是多因素的，需要积极的危机计划和管理。在评估高危患者时需要解决一系列问题。确定降低双相情感障碍自杀倾向的干预措施的有效性应该是研究的重点。

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