First and Subsequent Lifetime Alcoholism and Mental Disorders in Suicide Victims With Reference to a Community Sample-the Lundby Study 1947-1997

From Substance Use Disorders in Life to Autopsy Findings: A Combined Case-Record and Medico-Legal Study

Objectives: Several studies have shown mortality and suicide risk in substance use disorders, and autopsy findings with respect to the used substances. However, there seems to be a gap in the knowledge about substances misused in life and at death at the within-person level. Methods: All consecutive, autopsied patients during 1993 to 1997, who had been in contact with the Addiction Centre in Malmö from 1968, were investigated (365 subjects). Drug misuse in the long-term course noted in case records was related to autopsy findings. Self-inflicted death (suicide/undetermined suicide/accidental overdose) was compared with natural death. Results: Benzodiazepine misuse was associated with a high risk of autopsy findings of the substance in suicide and death of undetermined intent. It was also associated among non-misusers, but less so. An alcohol level above 1‰ was found more often in self-inflicted death. Prescription opioids at autopsy were mainly found in self-inflicted death among non-misusers. Heroin misuse was related to overdose. Central nervous system stimulants (CNS-S) and cannabis were rarely found in self-inflicted death among previous misusers. The overlap between depression in life and antidepressants at death was low. Conclusions: Benzodiazepines and alcohol seem to disinhibit suicidal tendencies. Suicide risk among users of cannabis and CNS-S may be related to other risk factors than acute use. Implications for suicide prevention are discussed.

A Survey of Clinical Approaches to Suicide Risk Assessment for Patients Intoxicated on Alcohol

BACKGROUND

Suicidal ideation and alcohol use are common among emergency department patients. It is unclear at what point a suicide risk assessment should occur among patients who present with acute alcohol intoxication.

OBJECTIVE

This study aims to describe practice patterns among expert practitioners for timing the suicide risk assessment for an intoxicated patient.

METHODS

An online survey was sent to emergency psychiatrists and behavioral health specialists on 2 national listserves including that of the Academy of Consultation-Liaison Psychiatry's Emergency Psychiatry Special Interest Group.

RESULTS

Sixty respondents had a mean of 16 ± 12years (mean ± standard deviation) out of specialty training and had extensive experience and comfort in managing this patient presentation. All respondents were board-certified and most (68%) practiced in academic settings. The most common practice for conducting a safety risk assessment in alcohol-intoxicated patients was to proceed once the patient was clinically sober (58%). Other practices included retesting the patient until a specific blood alcohol concentration was reached (19%) or waiting a certain time after presentation based on the initial blood alcohol concentration (15%). Some (8%) evaluated actively-intoxicated patients for suicide risk. Practice varied slightly based on the location of practice,type of practice, and where the clinician trained.

DISCUSSION

Expert clinicians most often describe using a clinical assessment to determine sobriety before completing a suicidal risk assessment, although alternative practices remain common. While advantages and disadvantages vary among different approaches, the quality and evidence base underlying these practices are questioned.