Perceived clinical utility of the suicide crisis syndrome: A multisite pilot study.

Perceived usefulness in the clinical setting is important in the implementation of novel constructs and assessments. The suicide crisis syndrome (SCS) has been proposed and validated as a theoretical framework for assessing acute suicide risk, but clinicians' perceptions of the SCS have not yet been examined. In this study, we evaluated perceived utility of the SCS across several provider locations to assess its perceived value as a clinical tool. A sample of 47 practitioners across three sites who had received education about, but no implementation of, the SCS, and a separate sample of 52 practitioners at a site that had systematically implemented the SCS, completed a survey assessing its feasibility, appropriateness, acceptability, incremental helpfulness, and overall clinical utility. In both samples, clinicians reported favorable ratings for feasibility, appropriateness, acceptability, incremental helpfulness, and overall clinical utility. In Sample 1, clinicians with previous experience using the SCS reported significantly higher ratings for all categories except incremental helpfulness than those without prior SCS use. In Sample 2, there were no significant differences in ratings between participants with or without prior use of SCS. Comparison of the two samples found no significant differences in all categories except acceptability, as those in Sample 2 showed significantly higher ratings. Regardless of implementation, clinicians reported generally favorable perceptions of the SCS, and those from the implementation sample reported significantly higher acceptability of its use. This suggests that clinicians may be supportive of the use and implementation of the SCS in clinical settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of the Abbreviated Suicide Crisis Syndrome Checklist on Clinical Decision Making in the Emergency Department.

Objective: The suicide crisis syndrome (SCS), an acute negative affect state predictive of near-term suicidal behavior, is currently under review for inclusion as a suicide-specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the predictive validity of the SCS for near-term suicidal behavior is well documented, its real-world clinical utility has yet to be evaluated. As such, this study evaluated how implementation of a novel assessment tool, the Abbreviated SCS Checklist (A-SCS-C), into the electronic medical records (EMRs) influenced disposition decisions in the emergency departments (EDs) of a large urban health system.Methods: Logistic regression analyses evaluated the impact of SCS diagnosis on 212 admission/discharge decisions after accounting for chief complaints of suicidal ideation (SI), suicidal behavior (SB), and psychosis/agitation.Results: The A-SCS-C was concordant with 86.9% of all non-psychotic disposition decisions. In multivariable analysis, the A-SCS-C had an adjusted odds ratio (AOR) of 65.9 (95% confidence interval: 18.79-231.07) for inpatient admission, whereas neither suicidal ideation nor behavior was a significant predictor. The effect size remained very high in 3 sensitivity analyses, the first using information from a different section of the EMR, the second in patients younger than 18 years, and the third in males and females separately (AORs > 30).Conclusions: SCS diagnosis, when implemented in ED EMRs alongside SI and SB, was strongly predictive of clinician decision making with regard to admission/discharge, particularly in non-psychotic patients, while SI and SB were noncontributory. Overall, our results show that the SCS, as a diagnostic entity, demonstrates robust clinical utility and may reduce the limitations of relying on self-reported SI as a primary basis of suicide risk assessment.

Review of the effectiveness of transcranial magnetic stimulation for post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is a psychiatric condition with significant morbidity and limited treatment options. Transcranial magnetic stimulation (TMS) has been shown to be an effective treatment for mental illnesses including major depressive disorder. OBJECTIVE: Review effectiveness of TMS for PTSD. METHODS: Literature review with descriptions of primary studies as well as meta-analysis of studies with a control group. RESULTS: Eight primary studies were identified and three studies met criteria for meta-analysis. All studies suggest effectiveness of TMS for PTSD. Additionally, right-sided may be more effective than left-sided treatment, there is no clear advantage in high versus low frequency, and the treatment is generally well tolerated. Meta-analysis shows significant effect size on PTSD symptoms that may be correlated with total number of stimulations. CONCLUSIONS: TMS for PTSD appears to be an effective and well-tolerated treatment that warrants additional study to further define treatment parameters, course, and side effects.