The little suicidal construction that could

The little suicidal construction that could

author’s note

The reader will note that the study discussed in this article does not use conceptually confounding sensitivity/specificity, exclusion bias in logistic regression, or unstable predictive value typically employed in suicide analyses. Instead, a multilayer neural network model with interval likelihood ratios (LRs), based on Bayes’ event probability theorem, is applied for the first time to differentiate extreme risk categories.

This paradigm shift is new to mental health but not new to medicine. For example, it is used in the diagnostic efficacy of strep throat at the point of care, the protocol of myocardial infarction (HEART), the S3 heart sound in heart failure, the ventilation perfusion scan in pulmonary embolism and the whirlpool sign in acute intracranial hemorrhage.

This essay can help you think outside the box about where accurate suicide risk assessment and stratification is essential. Please show your willingness to let go of preconceived ideas.


I have struggled with suicide studies for some time. The topic of suicide is complex, complicated, and obscure, and attempting to systematize risk stratification for the emergency department (ED) physician is considered by many to be the equivalent of the Freudian Plinko.

However, given its uniqueness, the consensus on suicide research continues to face a series of obstacles that limit its progress. The field is a gathering of “experts” in various disciplines with competing foundations, alliances, and associations, definitional problems, fragmentary data, interdisciplinary disputes, forensic coding errors, outdated statistical methods, and entrenched leadership. This continues to pose conflicts in communication and progress.

However, recently, an article appeared in the peer-reviewed scientific literature. Independently validated previous publications and this author’s central pillar, emphasizing that current ideation-focused suicide raters, such as the brilliant and well-funded Columbia-Suicide Severity Rating Scale (C-SSRS), are insensitive to the risk of suicide. suicide in the ED. At long last, based on the evidence, this ubiquitous “gold standard” has been given a well-deserved, objective narcissistic self-harm.

So, Dr. Copelan, please tell us, what is a sufficient suicide test, even if it’s just one?

A pattern of ideation events

In my writing, I have occasionally used or revised an analogy to explain some unfamiliar concepts and link these ideas to something familiar to you. For example, I have used this technique to help convey a point related to anaphylactic suicide and an equation for suicidal lethality. Let’s use this method once more.

As an example, and similar to HEART myocardial risk procedurethe assessment must differentiate, and admirably quickly, the quality (X), duration (Y), and degree (Z) of the currently monolithic ideation risk factor (or in this discussion, the equivalent of chest pain).

In this configuration, the ideation structure is sized to include fleeting, transitory, impermanent, enduring, permanent, correctable, contained, “absent” and “reversible” variables. Additionally, ideation modifiers should include age, gender, ethnicity, country of origin, family adversity, religion, dysexecutive states, previous illnesses, previous attempts, and substance abuse. And the motivators can be discriminated into ritual, rebirth, reunion, revenge, imitation, suicide by policeduty or compulsory, and Werther effect, among other components.

To complete this structure, “lack of ideation” is included here, since lack of ideation, similar to the absence of chest pain, can convey especially important clinical information in carefully scrutinized patients. “Reversible ideation” is associated with a particular and extreme risk stress cohort characterized by an astonishingly rapid transition to death within minutes. This is underlined in the Violence and Suicide Ideation Treatment Algorithm (VISTA), or what I will consider, “The Little Construct That Might,” a rewording of the “Little engine that could.

Study and publication history

“What is past is prologue” is a quote by William Shakespeare from his play The Tempest. In contemporary usage, the phrase represents the idea that history sets the context for the present. In 2006 I published a Original article in the American journal of emergency medicine. A tracing publication was issued in Pediatrics under review. These and other papers highlighted the specific assessment of a hitherto unrecognized cohort of youth, and proposed a neurological algorithm based on likelihood ratios and Markov chain probabilities to speed up its diagnosis.

Most suicidal ideators do not attempt it. Not everyone who tries to devise. A positive correlation has been observed between youth at extreme risk for suicide without ideation, alternatively referred to as anaphylactic suicide, and decreased ability to perform rapid alternating movements (RAM). Could a specific RAM test, analogous to the carotid sinus message in tachyarrhythmias, “distract” or temporarily restore acutely sequestered involved cortical circuits after an acute adjustment or stress reaction? Could the RAM test temporarily restore seized neurocognitive ability and facilitate early, life-saving treatment in this cohort?

The study examined a consecutive series of 43 carefully assessed, drug-naïve, first-episode young patients who were admitted to a high-volume emergency department. After meeting strict DSM-IV inclusion criteria, pattern recognition, and behavioral diagnostics, patients were randomly assigned to initial or modified ED treatment. There was a matched, non-fatal, deliberate self-harm control group. For all patients with dire presentations, safeguards included quality improvement and ethical requirements, societal value, perspective of clinical benefit, detailed informed consent, independent research advocate, trained staff, and a safe hospital environment. Subjects were administered a new neurocognitive test and a standardized RAM measure and were assessed for errors, logical rigidity, and reemergent ideation. Statistical analysis included the interval likelihood ratio to determine the magnitude of the anomaly in the categorical data.

A small but statistically significant sample result (interval odds ratio 7.5-17; 95% CI) suggested that timely AMR conditionally confirms and restores seized neurocognitive ability in acute stress disorder by activating control neural patterns. attention for. The rapid disclosure of previously inaccessible, yet alarming, ideation may indicate short-term improvement in functioning that facilitates early stabilization.

The value of hard work

It takes a lot of battered confidence and depleted energy to continue this fight, even when you know you’re on the right track of “medical necessity.” Whatever barriers exist to promising research approaches, this validated work, this single study now extended to diverse populations, must count for something. Meets accepted diagnostic standards. Balance risks and benefits. Perhaps one day the same benefits can be expected that entities have brought to other suicide disease initiatives.

Russell Copelan, MD (retired), He lives in Pensacola, Florida. He is a graduate of Stanford University and the UCLA School of Medicine. She trained in neurosurgery and completed her residency and fellowship in emergency department psychiatry at UC, Irvine, and the University of Colorado, Denver. He is a reviewer for Academic Psychiatry and founder of eMed Logic, a non-profit organization that creates and distributes violence assessments. Copelan is also a presenter for the National Association of School Psychologists (NASP) Speakers Bureau.

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