Suicidal ideation and attemptMANAGEMENT

PSYCHIATRIC PRESENTATIONS · 12 SECTIONS

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552 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Acute anxiety Acute psychosis Agitation:behavioral emergency Anorexia Nervosa (Medical Complications)Bipolar disorder Bipolar Disorder (Depressive Episode)Bipolar Disorder (Manic Episode)Bulimia Nervosa (Medical Complications)Catatonia Conversion disorder Factitious Disorder Failure to Cope (Social)Failure to Thrive Generalized Anxiety Disorder Homicidal Ideation Major Depressive Disorder Major depressive episode Malingering Neuroleptic malignant syndrome Panic Attack Post-Traumatic Stress Disorder (Acute)Schizophrenia Exacerbation Suicidal Ideation Suicidal ideation and attempt Suicide Attempt

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp58

Immediate safety and stabilization

›Immediate safety priorities

›Environment free of ligature risks

›Removal of belts

›Removal of cords

›Continuous observation level

›1 to 1 sitter for active intent

›Line of sight for moderate risk

›Security support

›Elopement risk plan

›Agitation escalation plan

›ABCs and vitals

›Airway protection threshold

›Hemodynamic instability triggers

›Capacity and consent

›Decisional capacity concerns

›Substitute decision maker needs

Time critical medical threats after attempt

›Medical emergency triggers

›Depressed level of consciousness

›Immediate resuscitation bay

›Airway management pathway

›Respiratory depression

›Bag valve mask readiness

›Naloxone pathway for suspected opioid toxicity

›Shock physiology

›IV access and fluids

›Hemorrhage control if trauma

›Hyperthermia

›Active cooling

›Serotonin syndrome differential

›Seizure activity

›Benzodiazepine first line

›Glucose check

Agitation and violence risk

›Behavioral emergency pathway

›Verbal de escalation

›Calm tone and simple choices

›Reduce stimulation

›Medication for severe agitation

›Antipsychotic options per local protocol

›Benzodiazepine options per local protocol

›Restraints

›Last resort

›Time limited and monitored

›Medical causes of agitation

›Hypoxia

›Hypoglycemia

Consultation and team activation

›Early consult triggers

›Psychiatry or crisis team

›Active plan or intent

›Recent attempt

›Toxicology

›Suspected ingestion

›Unknown substance exposure

›Social work

›Unsafe home environment

›Child protection concerns

›Pediatrics or adolescent medicine

›Age under local adult threshold

›Developmental vulnerability

02History/hx82

Presenting crisis details

›Current suicidal thoughts

›Intensity and frequency

›Passive death wish

›Active intent

›Plan characteristics

›Specificity

›Immediacy

›Preparatory behaviors

›Giving away possessions

›Farewell messages

›Protective factors

›Reasons for living

›Future oriented goals

Attempt and self harm history

›Suicide attempt history

›Number and recency

›Within 24 hours

›Within 1 month

›Lethality indicators

›Expectation of death

›Interrupted versus aborted attempt

›Medical consequences

›Loss of consciousness

›Need for medical treatment

›Prior self injurious behavior

›Non suicidal self injury

›Escalation pattern

Mental health and substance history

›Psychiatric history

›Major depressive episode features

›Anhedonia

›Hopelessness

›Psychosis features

›Command hallucinations

›Delusional guilt

›Mania or hypomania features

›Decreased need for sleep

›Impulsivity

›Anxiety and trauma features

›Panic symptoms

›PTSD symptoms

›Substance use history

›Alcohol use pattern

›Recent intoxication

›Withdrawal risk

›Drug use pattern

›Stimulants

›Opioids

›Substance related disinhibition

›Blackouts

›Impaired judgment

Social context and access to means

›Psychosocial stressors

›Relationship conflict

›Breakup

›Family conflict

›Academic or work stress

›Failure or suspension

›Job loss

›Legal or financial stress

›Charges

›Housing insecurity

›Access to lethal means

›Medications at home

›Large quantities

›High risk medications

›Sharps

›Unsecured blades

›Tools

›Firearms access

›In home

›In relatives home

Past care and engagement

›Prior treatment

›Psychiatric hospitalization

›Voluntary

›Involuntary

›Therapy engagement

›Current therapist

›Missed appointments

›Medication adherence

›Recent changes

›Side effects

›Safety planning history

›Prior plan use

›Barriers to use

03Physical Exam/exam55

General and neurologic

›Global assessment

›Appearance and distress

›Psychomotor agitation

›Psychomotor retardation

›Vital signs

›Fever

›Hypotension

›Level of consciousness

›AVPU status

›GCS threshold for escalation

›Neurologic exam

›Pupils

›Focal deficits

Mental status exam

›Mental status domains

›Speech and thought process

›Pressured speech

›Thought blocking

›Mood and affect

›Hopeless affect

›Labile affect

›Thought content

›Suicidal intent

›Homicidal ideation

›Perception

›Hallucinations

›Dissociation

›Insight and judgment

›Poor insight

›Impulsivity

Signs of intoxication or toxidrome

›Toxidrome screening

›Opioid toxidrome

›Miosis

›Bradypnea

›Anticholinergic toxidrome

›Dry mucosa

›Tachycardia

›Sympathomimetic toxidrome

›Diaphoresis

›Hyperreflexia

›Serotonin toxicity

›Clonus

›Hyperthermia

Trauma and medical complications

›Trauma screening

›Head injury signs

›Scalp hematoma

›Vomiting

›Neck and airway concerns

›Voice change

›Stridor

›Chest and abdominal exam

›Tenderness

›Guarding

›Skin exam

›Wounds needing care

›Infection signs

04Differential Diagnosis/ddx55

Primary psychiatric syndromes

›Psychiatric differentials

›Major depressive disorder with suicidal ideation

›ICD 10 F32.9

›SNOMED CT depressive disorder

›Bipolar disorder

›Mixed features risk

›ICD 10 F31.9

›Schizophrenia spectrum and other psychotic disorder

›Command hallucinations

›ICD 10 F20.9

›PTSD

›Reexperiencing and hyperarousal

›ICD 10 F43.10

›Borderline personality disorder traits

›Affective instability

›ICD 10 F60.3

Substance and medication related

›Substance and medication differentials

›Alcohol intoxication

›Acute disinhibition

›ICD 10 F10.129

›Substance induced mood disorder

›Temporal relation to use

›ICD 10 F19.94

›Withdrawal states

›Alcohol withdrawal

›ICD 10 F10.239

›Medication adverse effects

›Akathisia

›Steroid induced mood change

Medical and neurologic mimics

›Medical differentials

›Delirium

›Fluctuating attention

›SNOMED CT delirium

›Hypoglycemia

›Altered mental status

›ICD 10 E16.2

›Thyroid disease

›Hyperthyroidism anxiety

›ICD 10 E05.90

›CNS infection or inflammation

›Fever with confusion

›Meningitis encephalitis consideration

›Traumatic brain injury

›Recent head trauma

›ICD 10 S06.9X0A

Coding and clinical terminology

›Coding considerations

›Suicidal ideation

›ICD 10 R45.851

›SNOMED CT suicidal thoughts

›Suicide attempt

›ICD 10 T14.91

›SNOMED CT suicide attempt

›Personal history of self harm

›ICD 10 Z91.5

›SNOMED CT history of self harm

05Laboratory Tests/lt49

Core medical clearance set

›Baseline labs for medical contributors

›Point of care glucose

›Hypoglycemia threshold based on local lab reference

›Repeat after treatment if low

›Electrolytes and renal function

›Sodium mmol per L for confusion

›Creatinine for renal impairment

›Liver enzymes

›Hepatic injury from ingestion

›Chronic liver disease baseline

›Complete blood count

›Infection concern

›Anemia concern

Overdose and ingestion evaluation

›Toxicology oriented labs

›Acetaminophen level

›Draw at 4 hours after ingestion if timing known

›Repeat if extended release concern

›Salicylate level

›Repeat levels for rising concentration concern

›Acid base monitoring needs

›Ethanol level

›Intoxication contribution

›Withdrawal risk stratification

›Urine drug screen

›Limited diagnostic specificity

›Confirmatory testing needs for medico legal decisions

›Creatine kinase

›Rhabdomyolysis risk with agitation or immobility

›Renal protection planning

Pregnancy and sexual health considerations

›Reproductive health tests

›Pregnancy test

›All patients with pregnancy potential

›Imaging and medication planning

›STI testing when indicated

›Assault concern

›High risk exposure

Additional tests by presentation

›Targeted labs

›Thyroid stimulating hormone

›New mood or anxiety symptoms

›Thyrotoxicosis concern

›Venous blood gas

›Acid base concern

›pH and pCO2 in mmHg

›Lactate

›Sepsis concern

›Shock physiology

›Coagulation studies

›Anticoagulant exposure

›Bleeding concern

06Diagnostic Tests/dt49

Scoring Systems

›Risk stratification tools

›Columbia Suicide Severity Rating Scale

›Ideation severity

›Behavior assessment

›SAFE T framework

›Risk factors

›Protective factors

›ASQ for youth screening

›Brief screening in pediatric settings

›Positive screen workflow

›Limitations

›Tools do not replace clinical judgment

›Risk can change rapidly

MRI

›MRI indications in this context

›Neurologic red flags

›New focal deficit

›Concern for mass lesion

›Advantages

›No ionizing radiation

›Better soft tissue detail

›Limitations

›Time and availability

›Motion artifact in agitation

›CT indications in this context

›Head CT

›Head trauma concern

›Altered mental status unexplained

›Neck and chest imaging

›Airway injury concern

›Respiratory distress

›Advantages

›Rapid acquisition

›Broad availability

›Limitations

›Radiation exposure

›Incidental findings

Ultrasound (or US)

›Ultrasound applications

›Point of care ultrasound

›Volume status assessment in shock

›Lung ultrasound for respiratory failure

›Soft tissue ultrasound

›Abscess evaluation if wound infection

›Foreign body concern

›Advantages

›Bedside assessment

›No radiation

›Limitations

›Operator dependent

›Limited in obesity or gas

07Disposition/dispo36

Level of care decisions

›Disposition risk tiers

›High risk criteria

›Active intent with plan

›Recent suicide attempt

›Moderate risk criteria

›Suicidal ideation without intent

›Limited protective factors

›Lower risk criteria

›Passive thoughts only

›Strong protective factors and supports

›Documentation elements

›Rationale for disposition

›Means restriction plan

Admission and transfer

›Hospitalization indications

›Inpatient psychiatric admission

›Persistent intent

›Inability to maintain safety

›Medical admission

›Toxic ingestion requiring monitoring

›Medical instability

›Transfer criteria

›Need for pediatric psychiatry

›Need for ICU monitoring

Discharge readiness

›Discharge prerequisites

›No current intent

›Stable mental state

›Reliable safety plan

›Safe environment

›Responsible adult support for minors

›Removal or secure storage of lethal means

›Follow up within short interval

›Mental health appointment scheduled

›Primary care notified when appropriate

›Return precautions

›Worsening thoughts

›New plan or intent

08Treatment/t68

Safety planning and brief interventions

›Evidence based brief interventions

›Safety plan components

›Warning signs list

›Personal triggers

›Early symptoms

›Internal coping strategies

›Grounding techniques

›Distraction activities

›Social supports

›People to contact

›Safe places

›Professional resources

›Crisis line options

›Urgent clinic access

›Means restriction

›Secure medications

›Secure firearms

›Caring contacts

›Follow up message plan

›Appointment reminders

Pharmacotherapy for associated syndromes

›Medication approach principles

›Treat underlying psychiatric syndrome when indicated

›Depression management pathway

›Psychosis management pathway

›Avoid new sedatives solely to suppress ideation

›Focus on safety and definitive care

›Monitor for disinhibition risks

›Medication reconciliation

›Recent dose changes

›Adherence barriers

Agitation management

›Acute agitation treatment

›Non pharmacologic first line

›De escalation

›Sensory reduction

›Medication options per local protocol

›Antipsychotic for psychosis driven agitation

›ECG for QT prolongation risk when feasible

›Monitor for dystonia and akathisia

›Benzodiazepine for stimulant intoxication

›Respiratory depression monitoring

›Avoid in severe alcohol intoxication when unsafe

›Restraint monitoring bundle

›Frequent reassessment

›Circulation and skin checks

Toxicology treatment pathways

›Ingestion management

›Acetaminophen toxicity

›N acetylcysteine initiation per nomogram criteria

›IV protocol per local guideline

›Repeat acetaminophen and transaminases

›Salicylate toxicity

›Alkalinization strategy per toxicology

›Sodium bicarbonate infusion protocol per local guideline

›Target urine alkalinization monitoring

›Opioid toxicity

›Naloxone titration to adequate ventilation

›Repeat dosing based on recurrence

›Observe for renarcotization

›Serotonin toxicity

›Discontinue serotonergic agents

›Benzodiazepines for agitation

›Intensive monitoring for hyperthermia

Evidence and guideline framing

›Recommendation strength framework

›Suicide risk screening in ED

›ACEP Level B support for structured screening in appropriate populations

›ACEP Level C for tool selection based on local workflow

›Lethal means counseling

›Class I recommendation by expert consensus for safety planning elements

›Class IIa for caring contacts follow up strategies

09Special Populations/sp30

Pregnancy

›Pregnancy specific considerations

›Maternal fetal safety priorities

›Obstetric consult triggers

›Fetal viability considerations by gestational age

›Medication safety

›Avoid teratogenic agents when possible

›Shared decision making for acute agitation meds

›Imaging approach

›Prefer ultrasound when appropriate

›CT only when benefits outweigh risks

Geriatric

›Older adult considerations

›High lethality attempt risk

›Social isolation

›Medical comorbidity burden

›Medication sensitivity

›Lower starting doses for sedatives

›Delirium risk

›Cognitive assessment needs

›Dementia screening when indicated

›Capacity concerns

Pediatrics

›Youth and adolescent considerations

›Developmental context

›Impulsivity and peer influence

›Bullying and online harassment screening

›Family involvement

›Guardian notification expectations

›Family safety planning role

›School and community coordination

›School counselor liaison when appropriate

›Community mental health referrals

10Background/b30

Epidemiology

›Epidemiology overview

›Suicide as leading cause of death in adolescents and young adults

›Variation by region and demographics

›Higher risk with prior attempt

›Prior attempt as strongest predictor of future attempt

›Elevated risk shortly after ED visit

›Need for rapid follow up

›Common comorbidities

›Depression

›Substance use disorder

Pathophysiology

›Biopsychosocial model

›Neurobiology contributors

›Serotonergic dysfunction hypotheses

›Stress response dysregulation

›Psychological contributors

›Cognitive constriction

›Hopelessness

›Social contributors

›Trauma exposure

›Social isolation

Therapeutic Considerations

›Treatment rationale

›Safety planning as immediate harm reduction

›Skills for crisis moments

›Environmental risk reduction

›Addressing underlying drivers

›Treat mood and psychotic disorders

›Treat substance use disorders

›Continuity of care

›Rapid outpatient follow up improves engagement

›Post discharge contacts reduce repeat attempts

11Patient Discharge Instructions/pdi17

copy discharge instructions

›Discharge instruction text

›Safety plan copy provided

›Warning signs list

›Coping steps list

›Crisis supports

›Local crisis line number provided

›Emergency services for imminent danger

›Means safety at home

›Medications locked and counted

›Sharps secured

›Follow up plan

›Appointment date and location

›Transportation plan

›Return to ED now for

›Suicidal thoughts getting worse

›New plan or intent

›Feeling unable to stay safe

12References/r23

Clinical guidelines and consensus

›Guideline sources

›American Psychiatric Association practice guideline for the assessment and treatment of patients with suicidal behaviors

›Risk assessment principles

›Safety planning emphasis

›Joint Commission National Patient Safety Goal on suicide prevention

›Screening and risk assessment expectations

›Environmental safety in healthcare settings

›SAMHSA SAFE T framework

›Structured risk assessment approach

›Disposition guidance

›American Academy of Pediatrics guidance on youth suicide prevention

›Screening tools for adolescents

›Family centered safety planning

Evidence based tools and studies

›Evidence sources

›Columbia Suicide Severity Rating Scale validation literature

›Predictive validity for attempts

›Standardized severity language

›ED Safety Planning Intervention trials

›Reduced suicidal behavior with safety planning plus follow up contacts

›Improved outpatient engagement

›Lethal means counseling evidence

›Reduced access associated with reduced suicide deaths

›Counseling improves safe storage behaviors

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.