Understanding Suicide by Philippe Courtet

Author:Philippe Courtet
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

17.4.3 Hospitalization vs. Ambulatory Treatment

Beyond the preventive and supportive strategies that have been developed for acutely suicidal patients, chronically suicidal patients, such as BPD patients, need long-term interventions in ambulatory settings. Some authors advise against hospitalizing BPD patients in the management of self-harm because there is no evidence that it may prevent completion and it may paradoxically induce the patients to use self-harm behaviors help to become chronic (Paris 2004), but in case of acute suicidal crises inpatient treatment may be needed to prevent fatal outcomes (Oldham 2006).

Importantly, the targets of treatment should change over time. A recent study with 90 BPD patients has shown how acute stressors (depression) predict suicide attempts only during a year, while poor psychosocial functioning has long-term effects on suicide risk (Soloff and Chiappetta 2012b). Moreover, the authors underline the importance of rehabilitation treatments to prevent the poor psychosocial outcomes among these patients. We should also keep in mind that personality plays a larger role in the SB of young patients. Compared with older patients, Axis II comorbidity has been repeatedly associated with completed suicides among the young (Turecki 2005). In other words, the treatment of personality disorders should be particularly intensive for young people at risk.

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