Warning signs and treatment of acute suicide risk in psychiatric crises

• Observational, prospective studies in patients acutely admitted in psychological/psychiatric crises.
• Randomized controlled psychotherapeutic- and pharmacological studies in high-risk populations.
• Develop treatment alternatives for at-risk populations like patients with co-morbid brain disorders (e.g., epilepsy), substance use disorders, and psychoses.
• Biomarkers indicating high-risk conditions.
• Development of information material to patients, their social network, and the bereaved relatives.

We are integrated with Dept of acute psychiatry, St Olavs University hospital. It is an urgent need to offer patients in acute suicidal conditions fast acting, evidence-based treatments. It is a need for the patients and their next-of-kins have access to evidence-based psychotherapeutic- and pharmacological, long-term treatments to prevent or early recognize new episodes.

Based on our clinical experience and existing research we have developed research projects to better understand and treat the high-risk population.

For decades, it has been assumed that suicide occurred after long-term development in the individual. Prediction of suicide risk was based on categorical variables like presence of a major psychiatric disorder, previous suicide attempts, male gender, comorbid substance challenges, and old age.

The last two decades this has changed. For up to 70% percent of suicide victims it takes less than ten minutes from decision to act. Suicidal acts are impulsive phenomena. More than 50% of the victims die in the first attempt. When depressed, high-risk in-patient are assessed by experienced therapists, most patients deny any suicidal intention. Thus, the patients' own statements may be misleading.

Recent clinical experience and research data indicate that dynamic factors are most important in the assessments. Presence of immense affective states, anxiety, panic, agitation, global insomnia, and feelings of entrapment, hopelessness and shame are the important predictors. Most importantly, these dynamic factors are accessible to immediate, therapeutic interventions.  

Regional

• Nord-Trøndelag hospital trust, St Olavs University hospital.
• The Trøndelag Health Study (HUNT).

National

• Oslo University hospital, Stavanger University hospital, Haukeland University hospital.
• The NORSMI-network (Norwegian Research in Mental Illness) have partakers from hospitals in all Norwegian hospital trusts.
• The DEPTREAT-network. (Combining antidepressant and attention bias modification in primary health care). PMID: 37652355.
• The NORAAD-network (Norwegian studies on ketamine).
• The Norwegian Directorate of Health.
• The Norwegian Institute of Public Health.

International

• Mount Sinai Beth Israel hospital, Ichan School of Medicine, New York.
• The NORSMI-network with broad international collaboration.

Funding

The joint research committee between St Olavs hospital and the faculty of medicine and health sciences, NTNU; St Olavs hospital; The liaison committee between Central Norway Health Authority (RHA) and NTNU.